The Roles Of Early Collateral Circulation In The Prognosis Of STEMI Patients After PCI Therapy

?Background and Objective? Acute myocardial infarction(AMI)is a common critical clinical disease.Data showed that its incidence increased year by year i n recent years.The higher morbidity and mortality have brought enormous threat to individuals and society.Therefore,how to evaluate the prognosis of patients after myocardial infarction has become a focus in the study of medical workers.In terms of treatment,the key point of improving the prognosis of patients with AMI is as soon as possible to resume the myocardial blood perfusion.Main str ategies include percutaneous coronary intervention(PCI),thrombolysis therapy an d emergency coronary artery bypass.With the rapid development and wide appli cation of PCI technology,significant progress has been made in the reperfusion of acute myocardial infarction treatment.But prognosis in these patients still exis ted significant differences.Previous studies have discussed many factors that mig ht affect the prognosis of patients with AMI,such as age,Killip classification,d elay time of reperfusion,treatment patterns,past history of myocardial infarction,diabetes,renal dysfunction and coronary artery lesion counts etc.However,in r ecent years,the clinical researches pay more and more attention to the roles on the establishment of the coronary collateral circulation.Earlier studies showed tha t blood flow provided by the collateral circulation could reduce the area of myo cardial infarction,protect left ventricular function and reduce the application of a ortic balloon counterpulsation before PCI.But the viewpoint about whether collat eral circulation can improve the prognosis of patients is still disputed.So in the study,we observed the role of early establishment of the coronary collateral circ ulation in the prognosis of patients with acute STEMI undergoing emergency PCI after postoperative 12 months,to elucidate whether collateral circulation can im prove the prognosis of patients with acute STEMI.?Methods? A total of 257 patients with acute STEMI undergoing emergency P CI in Dalian Medical University affiliated No.1 hospital were enrolled from Janu ary 2014 to January 2015.According to whether presence of collateral circulatio n,these patients were divided into group A(collateral circulation group)(n=51)and group B(non-collateral circulation group)(n=206).Two groups of patients we re compared with postoperative left ventricular ejection fraction(LVEF),LVEF af ter postoperative 1 year,and the incidence of major adverse cardiovascular event s(MACE),malignant arrhythmia and ventricular aneurysm.?Results?1.Comparison between group A(collateral circulation group)and gr oup B(non-collateral circulation group): gender(percentage of male)(68.6% vs 77.2%,P=0.203),smoking history(45.1% vs 43.2%,P=0.807),hypertension(52.9% vs 48.5%,P=0.574),diabetes(19.6% vs 24.3%,P=0.481),TG(1.79±0.97 vs 1.54±0.96,P=0.103)mmol/L,TC(4.90±1.15 vs 4.78±1.06,P=0.469)mmol/L,LDL(2.91±0.88 vs 2.82±0.70,P=0.440)mmol/L,CR(71.08±18.85 vs 76.86±36.88,P=0.279)umol/L,multivessel disease(31.4% vs 20.9%,P=0.110),Killip classification?2(11.8% vs 17.5%,P=0.323),ischaemic time(h)(6.14±2.01 vs 5.54±2.33,P=0.096).The abov e basic information,P>0.05,there were no statistically significant difference.The re were statistically significant difference in age(year)(60.04±11.55 vs 63.80±12.05,P=0.045)and preinfarction angina(31.4% vs 11.2%,P<0.001)datas.Logistic regr ession analysis founded that preinfarction angina was the favorable factor(P<0.001)and age was the adverse factor for the formation of collateral circulation(P=0.008).2.Comparison of prognostic indicators between group A(collateral circula tion group)and group B(non-collateral circulation group):Postoperative LVEF(%)(52.10±7.739 vs 49.67±8.435,P=0.063),there was no statistically significant differ ence;LVEF after postoperative 1 year(%)(54.70±4.45 vs 51.31±6.67,P=0.008),the difference was statistically significant.MACE(3.9% vs 5.3%,P=0.955),maligna nt arrhythmia(5.9% vs 5.8%,P=1)and ventricular aneurysm(0% vs 2.4%,P=0.135),there were no statistical significant difference.After adjustment for confoun ding factors,such as age and pre-infarction angina,which were statistically signif icant difference between two groups,the collateral circulation was the protective factor influencing the LVEF after postoperative 1 year of patients with STEMI(P=0.004).?Conclusions?1.The early establishment of collateral circulation is beneficial to improving left ventricular function in patients with STEMI,but cannot significantly reduce the incidence of MACE events,ventricular aneurysm,and malignant arrhythmia within 12 months postoperatively.2.Age and pre-infarction angina have significant effect on establishment of collateral circulation.3.Gender,smoking history,hypertension,diabetes,TG,TC,LDL,CR,Killip classification and ischaemic time have no significant effect on the establishment of collateral circulation.