急性心肌梗死PCI术后预后与侧枝循环形成的关系研究

A Study on the Relationship between the Collateral Circulation Formation and Prognosis of Acute Myocardial Infarction Patients after PCI

目的:探讨急性心肌梗死(acute myocardial infarction,AMI)经皮冠状动脉介入治疗(percutaneous coronary interventions,PCI)术后预后与侧枝循环形成的关系。方法:选取2014年6月-2016年6月我院心脑血内科收治的AMI患者128例为研究对象,所有患者均行PCI术,根据是否有侧枝循环形成分为侧枝循环组(n=58)和无侧枝循环组(n=70)。比较两组患者的临床资料及随访6个月时左心射血分数(Left Ventricular Ejection Fractions,LVEF)和左心室舒张末期内径(left ventricular end diastolic diameter,LVDD)以及不良心血管事件(major adverse cardiovascular events,MACE)的发生情况。结果:两组性别、年龄、糖尿病、高血压、吸烟、缺血时间、甘油三酯(Triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(High-density lipoprotein cholesterol,HDL-C)、血糖水平比较差异均无统计学意义(P>0.05)。侧枝循环组术前低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)和心肌肌钙蛋白I(Cardiac troponin I,CTnl)峰值均显著低于无侧枝循环组,差异有统计学意义(P<0.05)。治疗前,两组LVEF、LVD比较,差统无计学意义(P>0.05);治疗后,侧枝循环组LVEF为(55.52±5.30)%,显著大于无侧枝循环组,LVDD为(46.43±3.37)mm,显著小于无侧枝循环组(P<0.05);侧枝循环组总MACE发生率18.97%,显著低于无侧枝循环组的45.71%(P<0.05)。经多因素分析,无侧枝循环形是MACE发生的独立危险因素(OR=1.648,95%CI:1.046-2.832,P=0.018)。结论:LDL-C和CTnl可能不利于侧枝循环形成,侧枝循环的存在可改善AMI患者PCI术后心功能、抑制心肌重构,降低MACE发生率,改善预后。

Objective： To explore the relationship between the collateral circulation formation and prognosis of acute myocardial infarction（AMI） patients after percutaneous coronary interventions（PCI）. Methods： 128 cases of AMI patients treated in cardiac cerebral blood medicine department of our hospital from June 2014 to June 2016 were selected for the study, and all patients were treated with PCI surgery and divided into the collateral circulation group （n=58） and the non-collateral circulation group （n=70） according to whether the collateral circulation was formed. The clinical data of two groups were compared, and the follow-up was taken for 6 months. The left ventricular ejection fi＇action （LVEF） and left ventricular end diastolic diameter （LVDD） and adverse cardiovascular events （MACE） were compared between the two groups. Results： There was no significant difference in the gender, age, diabetes, hypertension, smoking, ischemic time, Triglyceride （TG）, total cholesterol （TC）, High-density lipoprotein cholesterol （HDL-C）, blood glucose between the two groups （P〉0.05）. The peak values of low density lipoprotein cholesterol （LDL-C）and Cardiac troponin I （CTnl）of collateral circulation group before operation were significantly lower than those of the non-collateral circulation group （P〈0.05）. Before treatment, there was no significant difference in the LVEF and LVD between the two groups （P〉0.05）. After treatment, the LVEF was （55.52± 5.30） % in the collateral circulation group, which was significantly higher than that in the non-collateral circulation group while the LVDD was （46.43±3.37）mm, which was significantly lower than that in the non-collateral circulation group （P〈0.05）. The incidence rate of total MACE was 18.97 % in the collateral circulation group, which was significantly lower than that in the non-collateral circulation group with 45.71% （P〈0.05）. Multivariate analysis showed that the non-collateral circulation was an independent risk factor for MACE （OR= 1.648, 95% CI： 1.046-2.832, P=0.018）. Conclusions： LDL-C and CTnl may be not beneficial to the formation of collateral circulation. The presence of collateral circulation can improve cardiac fimction, inhibit myocardial remodeling, decrease the incidence of MACE and improve the prognosis of patients with AMI after PCI.