Yılmaz Cemalettin, Güvendi Şengör Büşra, Karaduman Ahmet, Tiryaki Muhammet Mücahit, Kültürsay Barkın, Unkun Tuba, Zehir Regayip
Department of Cardiology, Malazgirt State Hospital, Malazgirt, Muş, Turkey.
Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Kartal, Turkey.
J Hum Hypertens. 2025 Mar;39(3):210-216. doi: 10.1038/s41371-024-00986-3. Epub 2024 Dec 17.
Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as ≥65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334-0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.
冠状动脉侧支血流（CCF）对于患有阻塞性冠状动脉疾病的患者，尤其是ST段抬高型心肌梗死（STEMI）患者的心肌存活至关重要。然而，高血压会导致血管功能障碍并阻碍CCF的形成。宽脉压（WPP）定义为≥65 mmHg，与经典血压指标相比，可能能更好地反映心血管健康受损情况。WPP对CCF的影响仍不清楚。因此，我们旨在评估WPP对CCF的影响。这项回顾性研究纳入了2021年至2023年在一家三级医疗中心接受直接经皮冠状动脉介入治疗（PCI）的1180例STEMI患者。根据Rentrop分类将患者分为CCF良好组和CCF不良组。在这些患者中，272例（23.1%）CCF良好，而908例（76.9%）CCF不良。使用多变量逻辑回归分析构建了两个不同的模型，以确定CCF良好的独立预测因素，包括脉压（模型1）和WPP（模型2）。两个模型均纳入了年龄、性别、糖尿病、吸烟、梗死前心绞痛、Killip 3/4级、多支血管病变、肌钙蛋白峰值、心肌梗死溶栓前（TIMI）血流0级以及既往PCI等协变量。WPP被确定为对CCF良好有负面影响的独立预测因素（OR：0.511，95% CI：0.334 - 0.783，p = 0.002）。此外，糖尿病、梗死前心绞痛、Killip III/IV级、多支血管病变和TIMI血流0级也被发现是CCF的独立预测因素。源自血压测量的WPP与接受直接PCI的STEMI患者CCF不良相关，可能可作为CCF不良的预测指标。
