Chu Ai-Ai, Li Wei, Zhu You-Qi, Meng Xiao-Xue, Liu Guo-Yong
Department of Cardiology, Gansu Provincial Hospital.
Department of Cardiology, Qinghai Provincial Hospital, Xining.
Medicine (Baltimore). 2019 Aug;98(31):e16502. doi: 10.1097/MD.0000000000016502.
Investigate the effect of coronary collateral circulation (CCC) on the prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) and acute total occlusion (ATO) of a single epicardial coronary artery.Three hundred forty-six advanced-age patients (age ≥60 years) with STEMI and ATO who underwent primary percutaneous coronary intervention (PCI) were enrolled in this study. According to the Rentrop grades, the patients were assigned to the poor CCC group (Rentrop grade 0-1) and good CCC group (Rentrop grade 2-3).Multivariate logistic regression analysis revealed that poor coronary collateral circulation was an independent factor for Killip class ≥2 (odds ratio [OR]: -1.559; 95% confidence interval [CI]: 1.346-2.378; P = .013), the use of an intra-aortic balloon pump (IABP) (OR: -1.302; 95% CI: 0.092-0.805; P = .019), and myocardial blush grade (MBG) 3 (OR: 1.516; 95% CI: 2.148-9.655; P < .001). We completed a 12-month follow-up, during which 52 patients (15.0%) were lost to follow-up and 19 patients (5.5%) died. Univariate analysis (Kaplan-Meier and log-rank tests) suggested that poor CCC had a significant effect on all-cause mortality (P = .046), while multivariate analysis (Cox regression analysis) indicated that CCC had no statistically significant effect on all-cause mortality (P = .089) after the exclusion of other confounding factors. After excluding the influence of other confounding factors, this study showed that the mortality rate increased by 26.9% within 1 year for every 1-hour increment of time of onset. The mortality rate in patients with Killip class ≥2 was 8.287 times higher than that in patients with Killip class 0 to 1. The mortality rate in patients over 75 years was 8.25 times higher than that in patients aged 60 to 75 years. The mortality rate in patients with myocardial blush grade 3 (MBG 3) was 5.7% higher than that in patients with MBG 0-2.The conditions of CCC in the acute phase had no significant direct effect on all-cause mortality in patients, but those with good CCC had a higher rate of MBG 3 after primary PCI and a lower rate of Killip ≥2.
研究冠状动脉侧支循环（CCC）对老年急性ST段抬高型心肌梗死（STEMI）合并单支心外膜冠状动脉急性完全闭塞（ATO）患者预后的影响。本研究纳入了346例年龄≥60岁、因STEMI和ATO接受直接经皮冠状动脉介入治疗（PCI）的老年患者。根据Rentrop分级，将患者分为CCC不良组（Rentrop分级0 - 1级）和CCC良好组（Rentrop分级2 - 3级）。多因素logistic回归分析显示，冠状动脉侧支循环不良是Killip分级≥2级（比值比[OR]： - 1.559；95%置信区间[CI]：1.346 - 2.378；P = 0.013）、使用主动脉内球囊反搏（IABP）（OR： - 1.302；95% CI：0.092 - 0.805；P = 0.019）以及心肌灌注分级（MBG）3级（OR：1.516；95% CI：2.148 - 9.655；P < 0.001）的独立因素。我们完成了为期12个月的随访，期间52例患者（15.0%）失访，19例患者（5.5%）死亡。单因素分析（Kaplan - Meier法和log - rank检验）表明，CCC不良对全因死亡率有显著影响（P = 0.046），而多因素分析（Cox回归分析）表明，排除其他混杂因素后，CCC对全因死亡率无统计学显著影响（P = 0.089）。排除其他混杂因素的影响后，本研究表明，发病时间每增加1小时，1年内死亡率增加26.9%。Killip分级≥2级患者的死亡率比Killip分级0至1级患者高8.287倍。75岁以上患者的死亡率比60至75岁患者高8.25倍。心肌灌注分级3级（MBG 3）患者的死亡率比MBG 0 - 2级患者高5.7%。急性期的CCC情况对患者全因死亡率无显著直接影响，但CCC良好的患者在直接PCI后MBG 3级发生率较高，Killip≥2级发生率较低。
