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

  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.