急性 ST 段抬高型心肌梗死患者侧支循环对伴发慢性完全闭塞病变的影响：EXPLORE 随机对照试验的亚组分析。
Impact of collateralisation to a concomitant chronic total occlusion in patients with ST-elevation myocardial infarction: a subanalysis of the EXPLORE randomised controlled trial.
机构信息
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Medisch Spectrum Twente, Enschede, The Netherlands.
出版信息
Open Heart. 2018 Jul 16;5(2):e000810. doi: 10.1136/openhrt-2018-000810. eCollection 2018.
OBJECTIVE
The impact on cardiac function of collaterals towards a concomitant chronic total coronary occlusion (CTO) in patients with ST-elevation myocardial infarction (STEMI) has not been investigated yet. Therefore, we have evaluated the impact of well-developed collaterals compared with poorly developed collaterals to a concomitant CTO in STEMI.
METHODS AND RESULTS
In the EXPLORE trial, patients with STEMI and a concomitant CTO were randomised to either CTO percutaneous coronary intervention (PCI) or no-CTO PCI. Collateral grades were scored angiographically using the Rentrop grade classification. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) at 4 months were measured using cardiac magnetic resonance imaging. Well-developed collaterals (Rentrop grades 2-3) to the CTO were present in 162 (54%) patients; these patients had a significantly higher LVEF at 4 months (46.2±11.4% vs 42.1±12.7%, p=0.004) as well as a trend for a lower LVEDV (208.2±55.7 mL vs 222.6±68.5 mL, p=0.054) when compared with patients with poorly developed collaterals to the CTO. There was no significant difference in the total amount of scar in the two groups. Event rates were statistically comparable between patients with well-developed collaterals and poorly developed collaterals to the CTO at long-term follow-up.
CONCLUSIONS
In patients with STEMI and a concomitant CTO, the presence of well-developed collaterals to a concomitant CTO is associated with a better LVEF at 4 months. However, this effect on LVEF did not translate into improvement in clinical outcome. Therefore, the presence of well-developed collaterals is important, but should not solely guide in the clinical decision-making process regarding any additional revascularisation of a concomitant CTO in patients with STEMI.
CLINICAL TRIAL REGISTRATION
NTR1108.
目的
尚未研究侧支循环对伴有 ST 段抬高型心肌梗死（STEMI）的慢性完全闭塞（CTO）患者心功能的影响。因此，我们评估了与伴有 CTO 的 STEMI 相比，侧支循环良好与侧支循环不良对患者心功能的影响。
方法和结果
在 EXPLORE 试验中，STEMI 合并 CTO 的患者被随机分为 CTO 经皮冠状动脉介入治疗（PCI）或非 CTO PCI 组。采用 Rentrop 分级对侧支循环程度进行冠状动脉造影评分。通过心脏磁共振成像测量 4 个月时的左心室射血分数（LVEF）和左心室舒张末期容积（LVEDV）。162 例（54%）患者的 CTO 存在侧支循环良好（Rentrop 分级 2-3）；这些患者的 4 个月时 LVEF 显著更高（46.2±11.4% vs 42.1±12.7%，p=0.004），LVEDV 也呈降低趋势（208.2±55.7 毫升 vs 222.6±68.5 毫升，p=0.054）。与 CTO 侧支循环不良的患者相比，两组间总瘢痕量无显著差异。两组患者的长期随访结果显示，事件发生率无统计学差异。
结论
在 STEMI 合并 CTO 的患者中，CTO 存在侧支循环良好与 4 个月时的 LVEF 较高相关。然而，这种对 LVEF 的影响并未转化为临床结局的改善。因此，侧支循环良好很重要，但不应仅作为 STEMI 患者 CTO 进行额外血运重建的临床决策的唯一指导因素。
临床试验注册
NTR1108。
Zotero 插件