| Objective: The purpose of this study was to compare the clinical character, coronary artery lesion and the left ventricular function of acute myocardial infarction(AMI) with collateral circulation and non-collateral circulation by coronary angiography (CAG),left ventriculography (LVG),99mTc-methodxy isobutyl isomitrile (99mTc-MIBI) myocardial perfusion image (MPI) and equilibrium radionuclide angiography ( ERNA) to elucidate the influence factor about collateral circulation,the effect of collateral circulation on patients with AMI and the perhaps mechanisms.Methods: A total of 103 patients (88 male and 15 female, average age was 60.45±11.79 years old) who had persistent angina more than 20 minutes and the cardiac enzyme peak more than two folds of normal range and troponin positive and /or ECG ST segment elevation on 2 leads. Exclusions criteria was: the history of old myocardial infarction, thrombolysis treatment, the failure treatment of PCI, severe valvular heart disease, dilated and hypertropic cardiomyopathy, moderate and severe renal function failure. the mean interval from onset to the CAG was 10.54±7.34hours. According to the Rentrop grade we divided these patients into 2 groups: A group (collateral circulation group — Rentrop 1,2,3 grade, n=51) and B group (non-collateral circulation group — Rentrop 0 grade, n=52). In each group , we collect clinical information detailed included : risk factors ,the occurance of the NSTEMI,the compliance and mortality in-hospital, QCA ( the narrow more than 50 percent was positive), the record of LVEDP and left ventricular wall movement scores through LVG and blood dynamic monitor. All patients underwent ERNA and MIBI MPI in 1 week from the onset to evaluate the heart function and myocardial infarction area. In 2 groups, we compared their cardiac enzyme peak ,left ventricular wall movement scores and the ratio of acute ventricular aneurysm , and infarction areas in 99mTc-MIBI MPI, and left ventricular function parameters. All of these data underwent statistics test by SAS 6.12 software, p<0.05 should be think has the significant difference in statistics.Results: There had no significant difference between A and B group about age, sex, level of the cholesterol. In group A, the incidence of diabetes and addiction for smoking and drinking were lower than that in group B (15.68% vs 36.53%, 43.14% vs 59.61%,17.64% vs 40.38%, p<0.05, respectively), hypertension and preinfarction angina pectoris were higher than that in group B (56.80% vs 36.53% and 66.67% vs 38.46%, p<0.05, respectively). In group A, theincidence of non-ST segment elevated myocardial infarction (NSTEMI) was much higher than that in group B (19.6% vs 5.77% ,p<0.05), the incidence of heart failure and arrhythmia during PCI were lower than that in group B (29.41% vs 48.07% and 29.41% vs 44.23%,p<0.05, respectively). In group A, the percent of multivessel lesion was higher and the single vessel lesion incidence was lower than that in group B (31.37% vs 7.69% and 25.49% vs 44.23%,p<0.05, respectively). The ventricular wall movement Cortina scores and the incidence of ventricular aneurysms were lower than that in group B (6.45±0.94 vs 7.02±1.33 and17.64% vs 36.53%, P<0.05, respectively). In group A , the peak of creatine kinase and creatine kinase MB were much lower than that in group B(1237.17±760.23 vs 1772.40±872.28,160.58±73.70 vs 247.96±112.35, p<0.05, respectively). The myocardial infarction area of MPI was less than that in group B (14.98±3.72 vs 17.43±3.72, P<0.05). left ventricular ejection fraction (LVEF), left ventricular peak ejection rate (LPER), left peak failing rate (LPFR) in group A were higher than that in group B (53.598.6±9 vs 47.869.2±5, 2.81±0.79 vs 2.27±0.61 and 2.51±0.72 vs 2.06±0.56, p<0.01, respectively) the left ventricular time to peak ejection rate (LTPER), left ventricular time to peak filling rate (LTPFR) were lower (180.94±58.84 vs 230.88±75.11, 227.257±2.04 vs 313.61±84.41, p<0.01, respectively).Conclu...
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