The Risk Factor And Clinical Outcome Of Coronary Slow Flow For A Single Center Retrospective Case-control Study

Background:Coronary slow flow phenomenon?CSFP?refers to the found in coronary artery coronary angiography not obvious pathological changes,but appear distal perfusion delay phenomenon,and must be excluded coronary spasm or ectasia,cornary angioplasty,coronary thrombolysis,coronary emboli,valvular disease,cardiomyopathy,connective tissue disorders and therioma,etc.It has been more than 40 years since the discovery of CSFP from Tambe et al^[1].Coronary aterty angiography?CAG?remains a diagnostic coronary slow flow phenomenon?CSFP?"gold standard".Due to the wide application and popularization of CAG,CSFP is gradually valued and studied by cardiovascular interventional physicians.According to statistics,about l%-7%^[2-5]CSFP were found during coronary angiography,however,the incidence of coronary slow flow in domestic reports is inconsistent.myocardial perfusioimaging showed about 28%-75%of the coronary slow flow in patients with reversible perfusion abnormalities^[6-7],more than 80%of CSF with chest pain,a third of CSF patients with acute and readmission.Numerous studies have found that the risk factors for CSFP include age,gender,increased BMI,hyperuricemia,and smoking^[2,5,8-11]etc.In recent years,with the deepening of the clinicians to CSFP research,found that it is not accidental phenomenon of coronary angiography,but a kind of systemic disease clinical manifestations,at the same time it also has very important clinical significance and value.It may be related to angina^[12],acute myocardial infarction^[13],benign and malignant arrhythmia^[14],sudden cardiac death^[15-16],etc.May be due to the difference of research objects and research methods,a large number of domestic research reports the slow flow of the morbidity,risk factors and clinical outcomes and prognosis are not consistent,and is divided,is still in the argument.Treatment of CSFP still belongs to the research,groping stage,there is also a lack of long-term follow-up studies on its prognosis.Therefore,This topic will further study the morbidity,risk factors,clinical outcome and prognosis of patients with coronary slow flow.Objective:The morbidity,risk factors,clinical outcome and prognosis of coronary slow flow were retrospectively analyzed,to provide theoretical support for the standard prevention and treatment of coronary slow flow.Method:85668 cases of coronary arteriography in the Department of Cardiology of XiJing hospital by examining the contrast diac by 2006.8-2015.6.A total of 1465 cases of normal coronary arteriography were collected.The patients were divided into 2 groups by the combination of the Thrombolysis In Myocardial Infarction?TIMI?flow grade and corrected TIMI flow frame count method after CAG immediately:normal flow group?507cases?and slow flow group?958cases?.All patients were followed up by outpatient,telephone,letter,text message,WeChat and other forms.The number of patients in the two groups was:normal blood flow group?409 cases?and slow blood flow group?779 cases?.Basic clinical data?laboratory parameters and the follow-up results were compared between two groups.Logistic regression analysis was used to evaluate predictive value of CSF.Cox regression analysis was uesed to evaluate predictive values of clinical outcomes in CSF.The K-M curve was used to demonstrate the difference of survival rate of CSF endpoint events.The ROC curve was used to demonstrate the optimal cut-off value,sensitivity and specificity of CTFC values to prediction of CSF endpoint events.Results:1.By looking at the disc of 88665 coronary angiography patients from August 2006 to June 2015,958 patients with CSFP were screened.The morbidity of CSFP was 1.1%.2.Clinical characteristics and risk factors:The slow flow group had higher age?male?hyperlipidemia?smoker?taken Aspirin?Statins?Nitrates levels compared with the normal flow group?P<0.05?,lower LVEF compared with the normal flow group?P<0.05?;The slow flow group have higher white blood well count,hemoglobin,triglyceride,cystatin C and creatinine compared with the normal flow group?P<0.01?,have lower HDL-C level compared with the normal flow group?P<0.01?.Logistic regression analysis showed that slow flow group had higher age?p=0.01?,male?p=0.02?,smoker?p<0.01?,tabken aspirin?p<0.01?and statins?p<0.01?compared with normal flow group.3.Clinical outcomes:The slow flow group have higher incidence for angina?P<0.01?,exertional dyspnea?P<0.01?,palpitation?P<0.01?,cardiac death?P<0.01?,stroke?P<0.01?and composite terminal events?P<0.01?compared with normal flow group.K-M curve showed there have low survival rate of cardiac death,stroke,all cause death and composite terminal events in slow flow group.ROC curve showed there have poor insensitivity and specificity in CTFC values predicted cardiac death,stroke,all cause death and composite terminal events in coronary slow flow.Conclusion:1.By looking at 88665 coronary angiography discs,There were 958 cases of CSF screened.The morbidity of CSFP was 1.1%.2.Age,male,smoking are the predictors of coronary slow flow.coronary slow flow is the predictor of cardiac death,stroke,all cause death and composite terminal events.The slow flow group have higher incidence for angin,exertional dyspnea,palpitation and the proportion of taken aspirin and statins is high.3.The incidence of cardiac death,stroke and composite terminal events are higher in slow flow group.CSFP can diagnose coronary slow flow,but the degree of coronary slow flow was not related to the occurrence of cardiac death,stroke,all cause death and composite terminal events in patients with coronary slow flow.