前降支病变接受经皮冠状动脉介入治疗的冠心病患者侧支循环与心功能的关系

Relationship between collateral circulation and cardiac function recovery in patients receiving percutaneous coronary intervention for a single left anterior descending artery

目的探讨前降支单支病变且接受经皮冠状动脉介入（PCI）治疗的冠心病患者侧支循环的形成情况，并对其侧支循环与心功能之间的关系进行分析。方法人选自2010年1月～2012年12月在我院行冠状动脉造影提示前降支单支病变且行PCI的冠心病患者625例进行回顾眭分析，采用Rentrop法评价各组侧支循环的开放情况，并分为存在侧支循环组（A组，包括Rentrop分级1级、2级、3级，n=280）与无侧支循环组（B组，包括Rentrop分级0级，n=345）。A组根据侧支循环来源分为对侧侧支循环（A1组，n=200）、同侧埘侧侧支循环（A2组，n=44）、同侧侧支循环（A3组，n=36），分别比较A组、B组两组；A1组、A2组、A3组3组心功能恢复的差异。结果总侧支循环对心功能恢复的影响：相较于无侧支循环者，存在侧支循环组射血分数升高、脑钠肽前体降低、红细胞体积分布宽度降低的程度较大（P〈0．05），左室舒张末容积增大的程度较大（P〈0．05）；对侧侧支循环、同侧侧支循环、对侧＋同侧侧支循环3种情况下心功能恢复的关系：3种情况下心功能均有改善，对侧＋同侧侧支循环对心功能改善最佳，对侧侧支循环次之，同侧侧支循环最差。结论前降支病变接受PCI治疗冠心病患者存在侧支循环者对心功能的恢复更好；对侧＋同侧侧支循环较同侧侧支循环对心功能改善程度大，对侧侧支循环次之。

Objective To explore the relationship between coronary collateral circulation following percutaneous coronary intervention （PCI） for a single left anterior descending artery and the recovery of cardiac ftmction. Methods A total of 625 patients with coronary heart disease were retrospectively analyzed, who received selective coronary angiography demonstrating lesions involving a single left anterior descending artery and underwent stent placement between Januar35 2010 and December, 2012. According to Rentrop＇s classification, the patients were divided into group A （n=280） with Rentrop grades 1-3 and group B （n=325） with Rentrop grade 0. Group A were further divided into 3 subgroups according to the source of collateral circulation, namely group A1 （n=200） with contralateral collateral circulation, group A2 （n--44） with contralateral＋ ipsilateral collateral circulation, and group A3 （n=3~） with ipsilateral collateral circulation. The outcomes of cardiac function recovery were compared between groups A and B and between the 3 subgroups in group A. Results Compared with patients without collateral circulation, patients with collateral coronary circulation showed greater left ventricular ejection fraction increment and reduction in brain natriuretic peptide and red cell volume distribution width with also lower expansion left ventricular end-diastolic volume. Among the 3 subgroups in group A, cardiac function improvement was the most obvious in patients with contralateral＋ ipsilateral collateral circulation （group A2） followed by those in group A3, and was the worst in group A1. Conclusion The presence of collateral coronary circulation promotes cardiac function recovery in patients receiving PCI for lesions involving a single left anterior descending artery. Patients with contralateral＋ipsilateral collateral circulation have the best cardiac function improvement followed bv those with contralateral collateral circulation.