Determinants of collateral development in patients with acute myocardial infarction
Determinants of collateral development in patients with acute myocardial infarction
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DOI：
10.1002/clc.4960220911
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发表时间：
1999-09-01
影响因子：
2.7
通讯作者：
Sasayama, S
中科院分区：
文献类型：
--
作者：
Fujita, M;Nakae, I;Sasayama, S
背景：急性心肌梗死（AMI）患者梗死相关冠状动脉侧支循环的存在与否对梗死面积和由此产生的左心室功能有显著影响。然而，附带发展的决定因素尚未得到澄清。假设：本研究的目的是阐明人类侧枝发育的决定因素。方法：研究组包括248例患者（178例男性，70例女性，平均年龄63岁）在首次AMI发作后12小时内行冠状动脉造影。所有患者均表现为梗死相关动脉完全闭塞。根据对侧注射造影剂时闭塞冠状动脉的混浊程度，将梗死相关动脉灌注区域的侧支循环程度分为无、不良或良好。结果：248例患者中92例侧支循环发育良好，占37.1%。AMI前有心绞痛病史的患者络发达率为57%，显著高于无心绞痛病史患者的26% （p < 0.0001）。然后应用多元逐步逻辑回归分析来确定侧枝发展的预测因素。可能的侧支发展的决定因素是长期的梗死前心绞痛、冠状动脉疾病的严重程度、年龄、性别和冠状动脉危险因素（高血压、糖尿病、高胆固醇血症、吸烟）。该分析显示，AMI前有心绞痛病史是侧支发展的重要预测因子（p < 0.0001）。结论：AMI前的心绞痛病史是冠状动脉狭窄的临床标志。由于严重的冠状动脉狭窄可以提供刺激导致侧枝血管的发展，心绞痛史也可以作为侧枝血管的临床标志。
Background: The presence or absence of collateral circulation to the infarct-related coronary artery in acute myocardial infarction (AMI) significantly impacts on infarct size and resulting left ventricular function. However, the determinants of collateral development have not been clarified.Hypothesis: The purpose of this study was to elucidate the determinants of collateral development in humans.Methods: The study group consisted of 248 patients (178 men, 70 women; mean age 63 years) undergoing coronary angiography within 12 h after the onset of a first AMI. All patients exhibited complete occlusion of the infarct-related artery. The extent of collateral circulation to the area perfused by the infarct-related artery was graded as none, or poorly or well developed, depending on the degree of opacification of the occluded coronary artery on the contralateral injection of contrast.Results: Well-developed collateral circulation was observed in 92 of the 248 patients (37.1%). The prevalence of well-developed collaterals was 57% in patients with a history of angina pectoris prior to AMI, which was significantly (p < 0.0001) higher than the 26% in those without a history of angina. Multivariate stepwise logistic regression analysis was then applied to identify predictors of collateral development. Possible determinants of collateral development were longstanding preinfarction angina, severity of coronary artery disease, age, gender, and coronary risk factors (hypertension, diabetes, hypercholesterolemia, smoking). This analysis revealed that only the presence of a history of angina pectoris prior to AMI was a significant predictor of collateral development (p < 0.0001).Conclusions: A history of angina pectoris prior to AMI is a clinical marker for coronary stenoses. Since severe coronary stenoses can provide stimuli that lead to collateral development, it is reasonable that a history of angina would also be a clinical marker for collateral vessels.