老年急性心肌梗死患者梗死相关动脉侧支循环减少。

Reduced collateral circulation to the infarct-related artery in elderly patients with acute myocardial infarction.

作者信息

Kurotobi Toshiya, Sato Hiroshi, Kinjo Kunihiro, Nakatani Daisaku, Mizuno Hiroya, Shimizu Masahiko, Imai Katsuji, Hirayama Atsushi, Kodama Kazuhisa, Hori Masatsugu

机构信息

Cardiovascular Division, Osaka Minami National Hospital, Kawachinagano, Japan.

出版信息

J Am Coll Cardiol. 2004 Jul 7;44(1):28-34. doi: 10.1016/j.jacc.2003.11.066.

DOI:10.1016/j.jacc.2003.11.066

PMID:15234401

Abstract

OBJECTIVES

The purpose of this study was to investigate the hypothesis that circulation via collateral vessels to an infarct-related artery (IRA) is impaired with aging in patients with acute myocardial infarction (AMI).

BACKGROUND

Animal experiments have shown that advanced age blunts the development of new vessels in response to angiogenic cytokines.

METHODS

Of 3,573 consecutive patients with AMI, 1,934 patients who fulfilled the following criteria were enrolled in this study: 1) coronary angiograms were obtained within 72 h after the onset of AMI; and 2) IRA showed complete occlusion (Thrombolysis In Myocardial Infarction [TIMI] flow grade 0 or 1). Collaterals to the IRA were angiographically evaluated using the Rentrop score. Rentrop scores 1 to 3 were defined as demonstrating significant collaterals.

RESULTS

The prevalence of collaterals decreased with age, from 47.9%, 45.8%, 43.4%, to 34.0% in patients <50 years, 50 to 59 years, 60 to 69 years, > or =70 years, respectively (p < 0.001). Advanced age was an independent factor predicting the absence of collateral circulation to the IRA. In contrast, time to catheterization, history of angina pectoris, and preinfarction angina were independent predictors for the presence of collaterals. Multivariate analysis showed that the absence of collaterals was an independent predictor of in-hospital mortality in elderly patients > or =70 years (odds ratio, 15.6; 95% confidence interval, 3.5 to 69.6), although this finding was not significant in patients <70 years.

CONCLUSIONS

Advanced age is associated with decreased angiographic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.

摘要

目的

本研究旨在探讨急性心肌梗死（AMI）患者中，梗死相关动脉（IRA）通过侧支血管的循环随年龄增长而受损这一假说。

背景

动物实验表明，高龄会削弱对血管生成细胞因子的反应中新生血管的发育。

方法

在3573例连续的AMI患者中，1934例符合以下标准的患者纳入本研究：1）在AMI发病后72小时内进行冠状动脉造影；2）IRA显示完全闭塞（心肌梗死溶栓治疗[TIMI]血流分级为0或1）。使用Rentrop评分对IRA的侧支血管进行血管造影评估。Rentrop评分1至3被定义为显示有显著侧支血管。

结果

侧支血管的患病率随年龄下降，<50岁、50至59岁、60至69岁、≥70岁患者中分别为47.9%、45.8%、43.4%、34.0%（p<0.001）。高龄是预测IRA无侧支循环的独立因素。相比之下，导管插入时间、心绞痛病史和梗死前心绞痛是侧支血管存在的独立预测因素。多变量分析显示，无侧支血管是≥70岁老年患者住院死亡率的独立预测因素（比值比，15.6；95%置信区间，3.5至69.6），尽管这一发现在<70岁患者中不显著。