合并冠状动脉侧支循环的AMI患者临床及冠状动脉特征分析

Clinical and coronary features in patients with acute myocardial infarction combined with coronary collateral circulation

目的:探讨已建立冠状动脉侧支循环的初发急性心肌梗死患者临床及冠状动脉特征。方法:82例确诊为初发急性心肌梗死患者,按有无侧支循环分为有侧支循环组32例和无侧支循环组50例,对两组患者的心血管危险因素及冠状动脉病变特点进行比较分析。结果:和无侧支循环组相比,有侧支循环组患者吸烟比例(21.88%vs48.00%,P<0.05)、饮酒比例(12.50%vs34.00%,P<0.05)、糖尿病比例(9.38%vs32.00%,P<0.05)及心源性休克比例(6.25%vs24.00%,P<0.05)均较低。梗死前心绞痛比例(65.63%vs38.00%,P<0.05)及左室射血分数值[(61.05±7.85)%vs(55.84±13.95)%,P<0.01]有侧支循环组显著高于无侧支循环组。冠状动脉造影显示,有侧支循环组多支病变比例(66.67%vs52.00%,P<0.05)及梗死相关动脉为右冠状动脉比例(59.38%vs30.00%,P<0.01)显著高于无侧支循环组。结论:吸烟、饮酒及糖尿病不利于侧支循环的形成,侧支循环的形成有利于保存心肌梗死患者的心功能,降低心源性休克的发生率。

Objective： To study the clinical and coronary lesions characteristics in patients with acute myocardial infarction combined with coronary collateral circulation. Methods： Patients with acute myocardial infarction were divided into two groups according to the combination of coronary collateral circulation（ CCC）, CCC group（ n =32） and non- CCC group （ n = 50 ）. The clinical risk factors and characteristics of coronary lesions between the two groups were compared. Results： Compared with non-CCC group, the percentage of smoking was lower in CCC group （21.88% vs 48.00%, P 〈 0.05 ） and so were the alcohol consumption （ 12.50% vs 34.00%, P 〈 0.05 ）, the history of diabetes mellitus（9.38% vs 32.00%, P 〈0.05）, and cardiogenie shock（6.25% vs 24.00%, P 〈 0.05 ）. Patients with CCC had higher ratio of pre- infarction angina peetoris （65.63 % vs 38.00%, P 〈 0.05 ） and higher values of left ventricular ejection fraction [ （ 61.05 ± 7.85 ） % vs （ 55.84 ± 13.95 ） %, P 〈 0.01 ） ] than those in non-CCC group. The percentage of multi-vessel lesion（66.67% vs 52.00%, P 〈0.05） and occlusion of right coronary artery（59.38% vs 30.00%, P 〈 0.01 ） were significantly higher in CCC group than that in non- CCC group. Conclusion： Smoking, alcohol consumption and diabetes mellitus are inversely associated with the de- velopment of CCC. The development of CCC can preserve cardiac function of patients with myocardial infarction, reduce the incidence of cardiogenic shock.