Piek J J, van Liebergen R A, Koch K T, Peters R J, David G K
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
J Am Coll Cardiol. 1997 Feb;29(2):275-82. doi: 10.1016/s0735-1097(96)00499-8.
We sought to determine the predictive value of factors influencing coronary collateral vascular responses in humans.
There is limited information on the factors responsible for coronary collateral vascular development, despite the protective effect of collateral vessels in ischemic syndromes.
Angiography of the contralateral artery was performed during balloon coronary occlusion in 105 patients with single-vessel disease (left anterior descending coronary artery in 69 patients, left circumflex coronary artery in 4 patients, right coronary artery in 32 patients) and normal left ventricular function. Collateral vessels were graded according to the classification of Rentrop. The relative collateral vascular resistance was calculated in a subgroup of 34 patients by means of aortic pressure, coronary wedge pressure and collateral flow, defined as the transient increase of coronary blood flow velocity of the contralateral artery during balloon coronary occlusion. Ischemia during coronary occlusion was evaluated by the ST segment shift (mV) in a 12-lead electrocardiogram (ECG).
A multivariate logistic analysis of clinical and angiographic variables revealed duration of angina (> or = 3 months, p < 0.0001), lesion severity (> or = 75% diameter stenosis, p < 0.0001) and proximal lesion location (p = 0.02) as independent factors positively associated with recruitability of collateral vessels, whereas the use of nitrates exerted an independent negative effect (p = 0.01). The regression equation yielded an overall predictive accuracy of 80%. The presence of recruitable collateral vessels during coronary occlusion resulted in a higher coronary wedge/aortic pressure ratio (mean [+/- SD] 0.35 +/- 0.13 vs. 0.27 +/- 0.12, p < 0.005), a lower relative collateral vascular resistance (6.7 +/- 7.4 vs. 21.3 +/- 10, p < 0.001) and a reduction of ECG signs of ischemia (0.14 +/- 0.19 vs. 0.38 +/- 0.33 mV, p < 0.001). The relative collateral vascular resistance was the best predictor for recruitability of collateral vessels compared with the other variables related to collateral vascular growth (p < 0.05).
Clinical and angiographic variables predict recruitability of collateral vessels with an 80% overall accuracy. These findings are important for risk stratification of patients undergoing interventions for ischemic coronary syndromes.
我们试图确定影响人类冠状动脉侧支血管反应的因素的预测价值。
尽管侧支血管在缺血综合征中具有保护作用，但关于冠状动脉侧支血管发育的相关因素的信息有限。
对105例单支血管病变患者（69例左前降支冠状动脉病变、4例左旋支冠状动脉病变、32例右冠状动脉病变）且左心室功能正常者，在球囊冠状动脉闭塞期间进行对侧动脉血管造影。根据Rentrop分类法对侧支血管进行分级。在34例患者的亚组中，通过主动脉压力、冠状动脉楔压和侧支血流计算相对侧支血管阻力，侧支血流定义为球囊冠状动脉闭塞期间对侧动脉冠状动脉血流速度的短暂增加。通过12导联心电图（ECG）中的ST段移位（mV）评估冠状动脉闭塞期间的缺血情况。
对临床和血管造影变量进行多因素逻辑分析显示，心绞痛持续时间（≥3个月，p<0.0001）、病变严重程度（直径狭窄≥75%，p<0.0001）和近端病变位置（p=0.02）是与侧支血管可招募性呈正相关的独立因素，而硝酸盐的使用则产生独立的负面影响（p=0.01）。回归方程的总体预测准确率为80%。冠状动脉闭塞期间可招募侧支血管的存在导致较高的冠状动脉楔压/主动脉压力比值（平均值[±标准差]0.35±0.13比0.27±0.12，p<0.005）、较低的相对侧支血管阻力（6.7±7.4比21.3±10，p<0.001）以及心电图缺血征象的减轻（0.14±0.19比0.38±0.33mV，p<0.001）。与其他与侧支血管生长相关的变量相比，相对侧支血管阻力是侧支血管可招募性的最佳预测指标（p<0.05）。
临床和血管造影变量预测侧支血管可招募性的总体准确率为80%。这些发现对于接受缺血性冠状动脉综合征干预的患者的风险分层具有重要意义。
