An Analysis Of The Clinical And Coronary Lesion Features Of Collateral Circulations In Patients With Acute Myocardial Infarction

BackgroundAcute myocardial infarction is the most severe manifestation of coronary heart disease.With its sudden onset,rapid progress and high mortality,acute myocardial infarction has become a main cause of death of human beings.Adequate coronary collateral circulations can reduce the size of myocardial infarction,delay ventricular remodeling,protect left ventricular function,which have important clinical significance for the prognosis of patients.In recent years,people keep paying extensive attention to the factors affecting the formation of collateral circulations in coronary heart disease,including coronary artery stenosis,myocardial ischemia,fluid shear stress,hypertension,diabetes,various cytokines and so on,but the reports fail to agree.Research has shown that coronary collateral circulation formation is the result of coronary hemodynamic changes.The relationship between non-invasive hemodynamic parameters and establishment of adequate collateral circulations in acute myocardial infarction is not explicit yet,and domestic and international studies are slightly different.The results of relevant studies on the effects of myocardial ischemia before and after infarction on the formation of adequate collateral circulation,and the relationship between the characteristics of coronary lesions and collateral circulation in acute myocardial infarction,are also slightly different.ObjectiveTo explore the clinical influence factors on collateral circulations in patients with acute myocardial infarction,especially the influences of myocardial ischemia before and after infarction,non-invasive hemodynamic parameters,characteristics of coronary lesions on adequate collateral circulations,and provide scientific theoretical basis for clinical works.Materials and MethodsWe selected 156 patients with acute myocardial infarction from January 2015 to September 2017 in our hospital as subjects for study.According to coronary angiography results,patients were divided into two groups:good and poor collateral circulation group.Patients were analyzed by single-factor and multi-factors analysis,in order to illuminate the relationship among age,gender,history of hypertension,diabetes history,smoking history,pre-infarction angina,post-infarction myocardial ischemia non-invasive hemodynamic parameters,laboratory examination findings,degree of coronary stenosis,coronary artery lesion characteristics,mumbers of coronary lesion vessels and adequate collateral circulations.ResultsThere were no statistical differences between the two groups in age,gender,history of hypertension,diabetes history,smoking history,blood lipid levels,renal function,and glycosylated hemoglobin.But,pre-infarction angina(30.2%VS 15.5%),post-infarction myocardial ischemia(35.8%VS 16.5%),heart rate(75.36 +13.85 VS 80.63 + 16.15),diastolic blood pressure(80.75 + 11.97 VS75.79 + 13.83),and mean arterial pressure(97.25 + 13.46 VS 92.03 + 14.65)showed statistically significant differences.The further subgroup analysis of heart rate and diastolic blood pressure showed that diastolic blood pressure between 75-95 mmHg,heart rate<60 beats/min tend to form good collateral circulations,and the difference was statistically significant.However,there was no statistical difference in systolic blood pressure,pulse pressure.Right coronary artery,complete occlusion,proximal lesions,diffuse long lesions and double or triple vessel disease promoted formation of good collateral circulations significantly.Multivariate logistic regression analysis showed that post-infarction myocardial ischemia,heart rate,diastolic blood pressure,degree of infarct-related coronary artery stenosis,location of infarct-related coronary artery lesions,proximal vessels lesions and the formation of good collateral circulations in patients with acute myocardial infarction were related.Conclusion1.Pre-infarction angina and post-infarction myocardial ischemia are favorable factors for the formation of good collateral circulations in patients with acute myocardial infarction.2.Age,gender,history of hypertension,diabetes history,smoking history,blood lipid levels,and renal function have no statistically significant effect on the formation of good collateral circulations in acute myocardial infarction.3.The diastolic blood pressure,heart rate,and mean arterial pressure in acute myocardial infarction are related to the formation of good collateral circulations.Potentially,diastolic blood pressure between 75-95 mmHg and lower heart rate,are more conducive to the formation of good collateral circulations.But,the systolic pressure and pulse pressure have no statistically significant effect.4.The severity of coronary artery stenosis,numbers of coronary lesion vessels are associated with good collateral circulations,and complete occlusion lesion,proximal lesions,triple or double vessel disease may be more likely to form a good collateral circulation.