冠状动脉慢性完全闭塞病变侧支循环的预测因素和预后意义

Predictors and prognostic significance of good collateral circulation in patients with coronary chronic total occlusion

目的:在冠状动脉慢性完全闭塞病变(CTO)中,侧支循环的相关预测因素及侧支循环对患者的预后影响目前尚不清楚。本研究试图通过相关预测因素进一步推断冠状动脉侧支循环的成熟度,同时进一步探讨侧支循环对于患者预后的影响。方法:纳入2016年10月—2019年12月在新疆医科大学第一附属医院心脏中心接受经皮冠状动脉介入治疗(PCI)的CTO患者,根据Rentrop分级标准对患者的侧支循环情况进行评估,分为侧支循环良好组(Rentrop 2~3级,168例)和侧支循环不良组(Rentrop 0~1级,135例)。比较两组患者的临床资料,采用多因素logistic回归分析影响CTO患者冠状动脉侧支循环形成的因素,采用Kaplan-Meier生存曲线分析及多因素Cox回归分析探讨侧支循环良好组和不良组主要不良心脑血管事件(MACCE)的发生率是否有差异。结果:侧支循环不良组与良好组临床资料差异无统计学意义;侧支循环不良组中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞百分比均高于侧支循环良好组(均P<0.05)。多因素logistic回归分析显示,影响侧支循环形成的独立危险因素包括NLR(OR:0.434,95%CI:0.310~0.607;P<0.001)与Gensini评分(OR:0.992,95%CI:0.895~0.998;P<0.012)。随访15(10~33)个月,侧支循环良好组与不良组MACCE差异无统计学意义(14.1%∶13.7%,P=0.928)。结论:在CTO患者中,NLR升高是侧支循环不良的独立危险因素。侧支循环成熟度对于CTO患者的预后无显著影响。

Objective:In patients with chronic total occlusion(CTO),the predictors of coronary collateral circulation(CCC)and its effect on prognosis are still unclear.This study attempts to infer the maturity of CCC through related predictors and explore the impact of CCC on the prognosis.Methods:Patients with CTO who underwent percutaneous coronary intervention(PCI)in the heart center of the First Affiliated Hospital of Xinjiang Medical University from October 2016 to December 2019 were included.The Rentrop grade system was utilized to clarify the collateral vessels and all patients were divided into a good-CCC group(Rentrop 2-3,n=168)and poor-CCC group(Rentrop 0-1,n=135).The clinical data between the two groups were compared.Multivariate logistic regression analysis was used to analyze the influencing factors of CCC.Kaplan-Meier survival curve and multivariate Cox regression were used to explore whether there was a difference in the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)between the good-CCC group and poor-CCC group.Results:There was no significant difference in clinical data between the poor-CCC group and the good-CCC group.The ratio of neutrophils to lymphocytes(NLR)and neutrophils in the poor-CCC group was higher than those in the good-CCC group(both P<0.05).Multivariate logistic regression analysis showed that NLR(OR:0.434,95%CI:0.310-0.607;P<0.001)and Gensini score(OR:0.992,95%CI:0.895-0.998;P<0.012)were independent predictors for CCC.All patients were followed up for 15(10,33)months,there was no significant difference in MACCE between the good-CCC group and the poor-CCC group(14.1%vs.13.7%,P=0.928).Conclusion:In patients with CTO,increased NLR is an independent predictor for poor collateral circulation,and CCC maturity has no significant effect on the prognosis.