急性ST段抬高型心肌梗死患者冠状动脉侧支循环的影像学特点

Imaging features of coronary collateral circulation in patients with acute ST-segment elevation myocardial infarction

目的评价急性ST段抬高型心肌梗死(STEMI)合并只有一支主要心外膜急性冠状动脉完全闭塞(ATO)时冠状动脉侧支循环(CCC)的影像学特点。方法收集2016年9月至2018年6月在兰州大学第一医院住院的209例STEMI合并ATO患者和80例冠状动脉慢性完全闭塞(CTO)病变患者,所有患者都只有一支主要心外膜冠状动脉闭塞。根据发病时间将ATO患者分为第1~4组,相应发病时间为≤3h、3~6h、6~12h、12~72h,CTO患者为第5组,比较5组患者不同闭塞冠状动脉、不同冠状动脉优势型、左前降支是否绕过心尖等不同情况下CCCRentrop分级的差异,采用Spearman法分析CCC分级与发病时间的相关性。结果 5组患者同侧侧支循环、对侧侧支循环及最终Rentrop分级比较,差异均有统计学意义(均P<0.001);与第5组(CTO患者)相比较,第1组、第2组、第3组及第4组同侧侧支循环及对侧侧支循环Rentrop分级比较,差异均无统计学意义(均P>0.05),但最终Rentrop分级差异有统计学意义(P=0.039)。Spearman相关分析法显示,Rentrop分级水平与闭塞时间相关(r=0.577,P<0.001)。不同闭塞冠状动脉同侧侧支循环Rentrop分级比较,差异无统计学意义(P=0.065);但对侧侧支循环及最终Rentrop分级比较,差异均有统计学意义(均P<0.05)。不同冠状动脉优势及左前降支是否绕过心尖同侧侧支循环、对侧侧支循环及最终Rentrop分级比较,差异均无统计学意义(均P>0.05)。结论对于STEMI合并ATO患者,冠状动脉闭塞时间对CCC的影响较大,闭塞时间越长,Rentrop分级越高;不同闭塞动脉对CCC有较大影响,右冠状动脉闭塞时Rentrop分级最高,左前降支次之,左回旋支最低。

Objective To evaluate the imaging features of coronary collateral circulation (CCC) in acute ST-segment elevation myocardial infarction (STEMI) with acute total occlusion (ATO) of only one epicardial coronary artery.Methods A total of 209 patients combined STEMI with ATO and 80 patients with chronic total occlusion (CTO) admitted in our department from September 2016 to June 2018 were enrolled in the analysis.All patients had only one major epicardial coronary artery occlusion.According to the Rentrop classifi cation method (grade 0, 1, 2, 3), the grades of ipsilateral and CCC associated with infarcted vessels was evaluated, and the higher grade between ipsilateral and contralateral CCC was considered as the fi nal grade of the CCC of the occluded coronary artery.The patients with ATO were divided into 4 groups according to the onset time, the corresponding onset time of the fi rst, second, third and fourth group were ≤ 3 h, 3–6 h, 6–12 h, 12–72 h, respectively and the patients with CTO was defi ned as the fifth group.Chi-square test was used to compare the grades of CCC among five groups,different occluded coronary arteries, diff erent types of coronary dominance, and diff erent conditions of whether the anterior descending branch (LAD) crossing the apex or not.The Spearman method was used to analyze the correlation of the grades of CCC and onset time.Results Rentrop grades(including ipsilateral,contralateral,and fi nal grades) among fi ve groups were signifi cantly diff erent ( P <0.001). Compared with those in the fi fth group (CTO), ipsilateral and contralateral Rentrop grades in the fi rst four groups were not statistically diff erence ( P >0.04), but there was a signifi cant diff erence in the fi nal grade( P =0.039).Based on Spearman methods,there was a strong positive correlation between the onset time and Rentrop grading( r =0.577, P <0.001).There was no significant difference in the ipsilateral Rentrop grades between different occluded vessels ( P =0.065).But there was a significant difference in the contralateral and fi nal Rentrop grades between diff erent occluded vessels ( P <0.05).There were no signifi cant diff erences in the ipsilateral, contralateral and fi nal Rentrop grades for the diff erent types of coronary dominance, and for whether the anterior descending branch crossing the apex or not ( P > 0.05).Conclusions For patients with both STEMI and ATO, according to coronary artery angiography, coronary occlusion time has a great impact on grades of CCC.The longer the occlusion time, the higher the Rentrop grade.At the same time, occluded coronary artery also had a great infl uence on the Rentrop grades of CCC.Rentrop grade was the highest when RCA occluded, the second when LAD occluded, and the lowest when LCX occluded.