心肌梗死后冠状动脉侧支循环发展进程

The Progress of Collateral Circulation in Patients After Myocardial Infarction

目的:探讨心肌梗死后侧支循环出现的规律与特点。方法:回顾性分析自2005-06至2011-06在我科住院行选择性冠状动脉造影的心肌梗死患者1 524例的临床资料,根据患者行冠状动脉造影的时间和心肌梗死类型分为四组:24 h内急诊冠状动脉造影的ST段抬高型急性心肌梗死(STEMI)患者785例(24 h之内组);7天至2周内行择期冠状动脉造影的STEMI患者328例(7天至2周内组);STEMI 1个月以后行冠状动脉造影的陈旧性心肌梗死患者172例(1个月以上组);3天内行冠状动脉造影的非ST段抬高急性心肌梗死(NSTEMI)患者239例(NSTEMI组)。通过分析各组的影像资料,观察梗死相关动脉出现侧支循环的发生率;分别采用Rentrop’s分级和心肌梗死溶栓治疗临床试验(TIMI)分级对逆向侧支循环和同侧桥侧支循环水平进行评价。结果:各组总侧支循环的发生率依次为:24 h之内组20.5%、7天至2周内组42.7%、1个月以上组71.5%、NSTEMI组57.5%;其中逆向侧支发生率为:24 h之内组20.5%、7天至2周内组41.5%、1个月以上组60.5%、NSTEMI组48.5%;同侧桥侧支的发生率依次为:24 h之内组1.1%、7天至2周内组6.4%、1个月以上组36.0%、NSTEMI组18.4%。24 h之内组内有侧支循环亚组与无侧支循环亚组比射血分数增高、死亡率降低(P<0.05);7天至2周内组、1个月以上组、NSTEMI组有侧支循环亚组与无侧支循环亚组比差异无统计学意义(P>0.05)。结论:STEMI患者在12 h内就可以出现逆向侧支循环,随时间延长侧支循环发生率和水平增加。而同侧桥侧支循环多在心肌梗死1个月后出现,而且只见于病变完全闭塞或次全闭塞时。

Objective ： To investigate the characteristics of collateral circulation at different time stages in patients after myocardial infarc- tion （MI）. Methods：A total of 1524 MI patients who received elective coronary angiography （CAG） from 2005 to 2011 in our hospital were retrospectively analyzed. The patients were divided into 4 groups according to the time of CAG and the type of MI. Group A, n = 785,the patients with ST-segment elevation MI （STEMI） and received CAG within 24 hours of on set. Group B, n = 328, STEMI patients received CAG from 1 to 2 weeks. Group C,n= 172,the patients with old STEMI and received CAG after l month or even longer. Group D, n=239, the patients with Non STEMI （NSTEMI） and received CAG within 3 days after the onset. The incidences of collateral circulation in all patients were evaluated by imaging information, Rentrop＇ s classification and TIMI grade. Results：The incidences of general collateral circulation were 20. 5% in group A,42. 7% in group B,71.5% in group C and 57.5% in group D. Among them,the retrograde collateral flows were 20. 5% in group A,41.5% in group B,60. 5% in group C and 48.5% in group D. The antegrade bridging collateral flows were 1.1% in group A,6. 4% in group B,36. 0% in group C and18.4% in group D. In Group A,the patients with collateral circulation had higher ejection fraction and lower mortality than those without collateral circulation, P〈O. 05, while such differences were no statistic meaning in Groups B, C and D ,P〉0. 05 respectively. Conclusion： STEMI patients could have retrograde collateral circulation at 12 hours after the onset, and the chance increased as time went by. Antegrade bridging collateral circulation usually developed at 1 month after MI, and it only occurred in total or sub-total occlusive artery lesions.