Allahwala Usaid K, Weaver James C, Bhindi Ravinay
Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
The University of Sydney, Sydney, Australia.
Heart Vessels. 2020 Mar;35(3):291-296. doi: 10.1007/s00380-019-01493-z. Epub 2019 Sep 3.
The spontaneous recruitment of acute coronary collaterals in the setting of an ST elevation myocardial infarction (STEMI) is seen frequently in those patients undergoing primary percutaneous coronary intervention (pPCI) and is associated with improved clinical outcomes. However, it is unknown whether in patients who present with a recurrent STEMI, the degree of collateral recruitment remains the same as in the index procedure. We reviewed all patients presenting to our tertiary centre with a STEMI undergoing primary or rescue percutaneous coronary intervention (PCI) from July 2010 until December 2018. We identified patients who presented with a recurrent STEMI following their index procedure. We defined patients with poor collateral recruitment as Rentrop grade 0 or 1, whilst patients with robust collateral recruitment as Rentrop grade 2 or 3. Of the 1795 patients who were identified, there were 27 cases in 25 patients who presented with a repeat STEMI following their index procedure. The median time between cases was 12.8 days (IQR 2.3-589.5 days). Compared to the index case, there was no statistically significant difference in the degree of collateral recruitment in recurrent presentations (Z = - 0.378, p = 0.70). In those patients presenting more than 6 months following the index procedure, the median time between cases was 654.5 days (IQR 479.5-1151.9). There was no difference in the degree of collateral recruitment in recurrent presentations (Z = 0.000, p = 1.0). Cases which had poorer collateral recruitment in recurrent presentations were less likely to be current smokers (0% vs 50%, p < 0.001) and less likely to have diabetes (0% vs 27.3%, p < 0.05) The recruitment of spontaneous coronary collaterals remains constant in recurrent STEMI presentations suggesting an innate biological process rather than merely a manifestation of alteration of haemodynamic blood flow. Further investigations to identify these processes is required.
在ST段抬高型心肌梗死（STEMI）患者中，急性冠状动脉侧支循环的自发募集在接受直接经皮冠状动脉介入治疗（pPCI）的患者中很常见，并且与改善的临床结局相关。然而，对于出现复发性STEMI的患者，侧支循环募集程度是否与初次手术时相同尚不清楚。我们回顾了2010年7月至2018年12月期间在我们三级中心因STEMI接受初次或补救性经皮冠状动脉介入治疗（PCI）的所有患者。我们确定了在初次手术后出现复发性STEMI的患者。我们将侧支循环募集不良的患者定义为Rentrop 0级或1级，而侧支循环募集良好的患者定义为Rentrop 2级或3级。在确定的1795例患者中，有25例患者出现了27例初次手术后复发性STEMI。病例之间的中位时间为12.8天（四分位间距2.3 - 589.5天）。与初次病例相比，复发性病例中的侧支循环募集程度无统计学显著差异（Z = -0.378，p = 0.70）。在初次手术后6个月以上出现症状的患者中，病例之间的中位时间为654.5天（四分位间距479.5 - 1151.9）。复发性病例中的侧支循环募集程度无差异（Z = 0.000，p = 1.0）。复发性病例中侧支循环募集较差的病例当前吸烟者的可能性较小（0%对50%，p < 0.001），患糖尿病的可能性也较小（0%对27.3%，p < 0.05）。复发性STEMI病例中，自发冠状动脉侧支循环的募集保持不变，这表明这是一个先天性生物学过程，而不仅仅是血流动力学血流改变的表现。需要进一步研究以确定这些过程。
