急性ST段抬高型心肌梗死患者冠脉侧支循环形成不良的影响因素及对预后的指导意义

张燕; 王永进; 王琦; 丁钰轩

doi:10.12125/j.chj.202106005

急性ST段抬高型心肌梗死患者冠脉侧支循环形成不良的影响因素及对预后的指导意义

Influencing factors and prognostic significance of poor coronary collateral circulation in patients with acute ST-segment elevation myocardial infarction

摘要

摘要:
目的探讨急性ST段抬高型心肌梗死（STEMI）患者冠脉侧支循环(CCC)形成不良的影响因素及对预后的影响。
方法选取2016年5月至2020年1月在我院心血管内科住院并接受PCI手术治疗的STEMI患者110例，依据Rentrop分级将患者分为CCC形成良好组和CCC形成不良组，比较两组患者临床资料，采用Logistic回归法分析STEMI患者CCC形成不良的影响因素，并建立CCC形成不良的预测模型。术后对患者随访1年，比较两组患者心血管事件发生率及全因死亡率。
结果单因素和多因素Logistic回归分析结果显示，无梗死前心绞痛、无梗死后心肌缺血、Killip心功能分级≥Ⅱ级、病变血管支数及冠状动脉狭窄程度均为STEMI患者CCC形成不良的独立危险因素（P<0.05）。利用以上独立危险因素构建列线图模型，其一致性指数（C-index）为0.756（95%CI：0.711~0.801），ROC曲线AUC为0.766（95%CI：0.709~0.823），具有较好的区分度；Calibration校准曲线评价结果提示模型准确性较好。两组患者术后1年心血管事件发生率无显著差异，但CCC形成良好组STEMI患者全因死亡率与CCC形成不良组比较显著降低（P<0.05）。
结论无梗死前心绞痛、无梗死后心肌缺血、Killip心功能分级≥Ⅱ级、病变血管支数及冠状动脉狭窄程度是STEMI患者CCC形成不良的独立危险因素，CCC形成良好与否对STEMI患者PCI术后1年心血管事件发生率无显著影响，但CCC形成良好对降低STEMI患者全因死亡率具有积极作用。

Abstract:
AIM To investigate the influencing factors of poor coronary collateral circulation (CCC) formation in patients with ST-segment elevation myocardial infarction (STEMI) and its effect on prognosis.
METHODS A total of 110 STEMI patients who were hospitalized in the Department of Cardiovascular Medicine of our hospital and underwent PCI surgery from May 2016 to January 2020 were selected. The patients were divided into good CCC group and bad CCC group according to Rentrop classification, and the clinical data of the two groups were compared. Logistic regression was used to analyze the influencing factors of poor CCC formation in STEMI patients and a prediction model of poor CCC formation was established. Patients were followed-up for 1 year and the incidence of cardiovascular events and all-cause mortality were compared between the two groups.
RESULTS Univariate and multivariate logistic regression analysis showed that no preinfarct angina pectoris, no post-infarct myocardial ischemia, Killip cardiac function grade ≥Ⅱ, the number of diseased vessels and the degree of coronary artery stenosis were independent risk factors for poor CCC formation in STEMI patients (P<0.05). The above independent risk factors were used to construct the nomogram model, and the C-index and AUC of the ROC curve were 0.756 (95%CI: 0.711-0.801) and 0.766 (95%CI: 0.709-0.823), showing a good degree of differentiation. Calibration curve evaluation results indicated that the accuracy of the model was good. The incidence of cardiovascular events 1 year after surgery was not significantly different between the two groups, but the all-cause mortality of STEMI patients in the group with good CCC formation was significantly lower than that in the group with poor CCC formation (P<0.05).
CONCLUSION No preinfarct angina pectoris, no post-infarct myocardial ischemia, Killip cardiac function grade ≥Ⅱ, the number of disaffected vessels and the degree of coronary artery stenosis are independent risk factors for poor CCC formation in STEMI patients. Good or bad CCC formation has no significant effect on the incidence of cardiovascular events in STEMI patients 1 year after PCI. However, good coronary collateral circulation formation plays a positive role in reducing the all-cause mortality of STEMI patients.

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