Study On The Influencing Factors And Clinical Significance Of Coronary Collateral Circulation

Background and Purpose : The coronary collateral circulation(CCC)often be found in coronary heart disease(CHD)patients with severe coronary lesions when we do coronary angiography,but the degree of coronary collateral circulation in patients is notably different,otherwise,a better coronary collateral circulation will play an important role in prevent myocardial necrosis,maintain heart function,decrease ventricular aneurysm and prolong survival time for patients with reperfusion therapy treatment opportunity[1 3].There are many factors influencing the establishment of coronary collateral circulation,this study aims to explore various clinical factors’ influence on the formation and establishment of coronary collateral circulation and discuss its clinical significance.Objects and methods: Continuous collected the hospitalized patients of non ST seg-ment elevation acute coronary syndrome(NSTEACS)in June 2016 to June 2017 in The First Hospital of Jilin University,and did coronary angiography(CAG)confirmed that they had one coronary artery occlusion at least,after admission,the patient history was inquired in detail and relevant inspection were conducted.,the results of relevant inspection and coronary angiography were recorded.According to the coronary angiography results,the patients were divided into the group with good collateral circulation and poor collateral circulation according to the Rentrop grading method.The SPASS 22.0 was used to analyze the relevant data of the two groups of patients to conduct this study.Results: 1.In terms of clinical baseline data,single-factor analysis found that there was a significant difference in gender composition between the CCC good group and the CCC poor group(P < 0.05),and the proportion of males in the CCC good group was higher (74.31%).There were no significant differences in age,smoking,drinking,diabetes and hypertension between the CCC good group and the CCC poor group(P > 0.05).Logistic regression revealed that diabetes was associated with CCC(OR:15.790;95% CI: 2.032 122.704;P < 0.008).2.Biochemical indicators: Single-factor analysis showed that the level of lipoprotein(a)[a Lp(a)] was different between the good CCC group and the poor CCC group(P < 0.05),and the good CCC group had a higher level of a Lp(a).There was no difference between the two groups in terms of blood lipid [except a Lp(a)],fasting blood glucose,serum uric acid(Scr),thyroid relevant hormone((FT3、FT4、TSH)),creatinine,red cell distribution width(RDW),lymphocyteto-monocyte ratio(LMR),etc.(P > 0.05).Stepwise exploration and analysis by Logistic regression model found that serum uric acid in blood was associated with CCC(OR:1.270;95 % CI: 1.003~1.019;P<0.047)。 3.Coronary artery lesion characteristics: Single factor analysis found that the coronary artery occlusion position(proximal and distal segments)and the occlusion of blood vessels(LAD,LCX,RCA)composition,Gensini score are differences between good and poor CCC group(P < 0.05),and occluded blood vessels count(single,double,multiple branch)form there is no difference between the two groups(P > 0.05);In the CCC good group,proximal vascular occlusion(56.94%)and RCA occlusion(61.11%)accounted for a higher proportion,and the Gensini score was also relatively high.Stepwise Logistic regression analysis showed that RCA occlusion and high Gensini score were associated with the formation of good CCC.4.In terms of cardiac function,: Single factor analysis failed to find differences in B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular posterior wall(LVPW),and left ventricular end diastolic diameter(LVDd)between the CCC good group and the CCC poor group(P > 0.05),however,there was a statistically significant difference in hypersensitive troponin I(hs-c Tn I)between the two groups(P=0.026),hs-c Tn I was relatively low in good CCC group.Analyzed between different levels of Rentrop classification,showed a statistically significant downward trend with the increase of Rentorp grading(r=-1.75,P=0.002),but failed to find a statistically significant change in the above indexes with the increase of Rentorp grading(all have P>0.05).Conclusions: 1.Male patients with coronary arteries chronic occlusion are more likely to establish good CCC,and diabetes is not conducive to the establishment of CCC.2.Patients with good CCC had high a Lp(a)levels。High levels of blood uric acid are not conducive to the establishment of good CCC.3.Proximal vessel occlusion,high Gensini integral and RCA occlusion were more likely to form good CCC.4.There was no significant relationship between CCC condition and heart function,however,good CCC can reduce the degree of myocardial necrosis.