Pérez-Castellano N, García E J, Abeytua M, Soriano J, Serrano J A, Elízaga J, Botas J, López-Sendón J L, Delcán J L
Department of Cardiology, Gregorio Marañón University General Hospital, Madrid, Spain.
J Am Coll Cardiol. 1998 Mar 1;31(3):512-8. doi: 10.1016/s0735-1097(97)00521-4.
Our purpose was to study whether the in-hospital prognosis of anterior acute myocardial infarction (AMI) is influenced by preexistent collateral circulation to the infarct-related artery.
Collateral circulation exerts beneficial influences on the clinical course after AMI, but demonstration of improved survival is lacking.
We studied 238 consecutive patients with anterior AMI treated by primary angioplasty within the first 6 h of the onset of symptoms. Fifty-eight patients with basal Thrombolysis in Myocardial Infarction (TIMI) flow >1 in the infarct-related artery or with inadequate documentation of collateral circulation were excluded. Collateral channels to the infarct-related artery before angioplasty were angiographically assessed, establishing two groups: 115 patients (64%) without collateral vessels (group A) and 65 patients (36%) with collateral vessels (group B).
There were no differences in baseline characteristics between groups A and B, except for the greater prevalence of previous angina in group B (15% vs. 34%, p = 0.003). During the hospital stay, 26 patients (23%) in group A and 5 (8%) in group B died (p = 0.01). Cardiogenic shock accounted for 74% of deaths. Cardiogenic shock developed in 30 patients (26%) in group A and in 4 (6%) in group B (p = 0.001). The absence of collateral circulation appeared to be an independent predictor of in-hospital death (odds ratio 3.4, 95% confidence interval 1.2 to 9.6, p = 0.02) and cardiogenic shock (odds ratio 5.6, 95% confidence interval 1.9 to 17, p = 0.002).
Preexistent collateral circulation decreases in-hospital death from anterior AMI by reducing the incidence of cardiogenic shock.
我们的目的是研究梗死相关动脉预先存在的侧支循环是否会影响前壁急性心肌梗死（AMI）的院内预后。
侧支循环对AMI后的临床病程具有有益影响，但缺乏生存率改善的证据。
我们研究了238例症状发作后6小时内接受直接血管成形术治疗的连续性前壁AMI患者。排除58例梗死相关动脉基础心肌梗死溶栓（TIMI）血流>1或侧支循环记录不充分的患者。血管成形术前对梗死相关动脉的侧支通道进行血管造影评估，分为两组：115例（64%）无侧支血管的患者（A组）和65例（36%）有侧支血管的患者（B组）。
A组和B组的基线特征无差异，但B组既往心绞痛的患病率更高（15%对34%，p = 0.003）。住院期间，A组26例（23%）患者和B组5例（8%）患者死亡（p = 0.01）。心源性休克占死亡病例的74%。A组30例（26%）患者发生心源性休克，B组4例（6%）患者发生心源性休克（p = 0.001）。无侧支循环似乎是院内死亡（比值比3.4，95%置信区间1.2至9.6，p = 0.02）和心源性休克（比值比5.6，95%置信区间1.9至17，p = 0.002）的独立预测因素。
预先存在的侧支循环通过降低心源性休克的发生率降低前壁AMI的院内死亡率。
