Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study
Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study
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DOI：
10.1136/bmjopen-2016-011105
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Komuro, Issei
中科院分区：
文献类型：
--
作者：
Hara, Masahiko;Sakata, Yasuhiko;Komuro, Issei
目的：评价经皮冠状动脉介入治疗（PCI）时代ST段抬高型心肌梗死（STEMI）后急性期冠状动脉侧支对闭塞梗死相关动脉（伊拉）的短期和长期预后影响。设计：一项前瞻性观察研究。设置：日本大坂急性冠状动脉功能不全研究（OACIS）。参与者：来自OACIS数据库的3340名STEMI患者，他们在发病后24小时内入院，伊拉完全闭塞。根据入院时血管造影的Rentrop侧支循环评分（RCS）将患者分为4组（RCS-0，无可见侧支循环; RCS-1，无伊拉填充的侧支循环; RCS-2，部分伊拉填充的侧支循环; RCS-3，完全伊拉填充的侧支循环）。主要结果指标：住院和5年死亡率。RCS-0/3患者的年龄大于RCS-1/ 2患者，且RCS-3患者既往心肌梗死的患病率最高。随着RCS的增加，肌酐磷酸激酶峰值水平中位数降低（p< 0.001），表明侧支循环具有急性心脏保护作用。尽管RCS-1和RCS-2侧支循环与更好的住院死亡率相关，（RCS-1和RCS-2的校正OR分别为0.48，p= 0.046和0.38，p= 0.010）和5年死亡率（RCS-1和RCS-2的校正HR分别为0.53，p= 0.004和0.46，p< 0.001）与R-0相比，RCS-3侧支循环的存在与院内改善无关（调整OR 1.35，p= 0.331）和5年死亡率（校正HR 0.98，p= 0.920），可能是因为RCS-3患者的临床特征较差，可能掩盖了冠状动脉侧支循环的死亡率获益。在当代PCI时代，急性期冠状动脉侧支循环（如RCS-1和RCS-2）的存在与STEMI后较好的住院死亡率和5年死亡率相关。
Objectives: To evaluate the short-term and long-term prognostic impacts of acute phase coronary collaterals to occluded infarct-related arteries ( IRA) after ST-elevation myocardial infarction ( STEMI) in the percutaneous coronary intervention ( PCI) era.Design: A prospective observational study.Setting: Osaka Acute Coronary Insufficiency Study ( OACIS) in Japan.Participants: 3340 patients with STEMI from the OACIS database who were admitted to hospitals within 24 hours from the onset and who had a completely occluded IRA.Interventions: Patients were divided into 4 groups according to the Rentrop collateral score ( RCS) by angiography on admission ( RCS-0, no visible collaterals; RCS-1, collaterals without IRA filling; RCS-2, collaterals with partial IRA filling; and RCS-3, collaterals with complete IRA filling).Primary outcome measures: In-hospital and 5-year mortality.Results: Patients with RCS-0/3 were older than patients with RCS-1/ 2, and the prevalence of previous myocardial infarction was highest in patients with RCS-3. Median peak creatinine phosphokinase levels decreased as RCS increases ( p< 0.001), suggesting the acute cardioprotective effects of collaterals. Although RCS-1 and RCS-2 collaterals were associated with better inhospital mortality ( adjusted OR 0.48, p= 0.046 and 0.38, p= 0.010 for RCS-1 and RCS-2, respectively) and 5-year mortality ( adjusted HR 0.53, p= 0.004 and 0.46, p< 0.001 for RCS-1 and RCS-2, respectively) as compared with R-0, presence of RCS-3 collaterals was not associated with improved in-hospital ( adjusted OR 1.35, p= 0.331) and 5-year mortality ( adjusted HR 0.98, p= 0.920), possibly because worse clinical profiles in patients with RCS-3 may mask mortality benefit of coronary collaterals.Conclusions: Presence of acute phase coronary collaterals such as RCS-1 and RCS-2 were associated with better in-hospital and 5-year mortality after STEMI in the contemporary PCI era.