Analysis Of Related Factors Of Coronary Collateral Circulation In Patients With Acute STEMI

Objective:To investigate the factors affecting the formation of early coronary collateral circulation in patients with acute STEMI,and to explore the predictive value of relevant biochemical indicators for collateral formation in patients with acute STEMI.Methods:According to the inclusion criteria and exclusion criteria developed in this study,100 patients with acute STEMI who underwent emergency coronary angiography from December 2017 to December 2018 in the Department of Cardiology,Jiangsu Subei People's Hospital were selected.General clinical data was collected in detail.The patients were enrolled in the fasting blood before the operation and on the second day of the next day,and the laboratory tests such as blood routine,blood lipid analysis,myocardial infarction,and homocysteine were completed.The severity of coronary stenosis was assessed by two experienced interventional cardiologists after improving emergency coronary angiography.The degree of coronary artery lesion and the location of CCC were assessed according to Rentrop classification standard.At least one major coronary artery(left anterior descending artery,right coronary artery,circumflex artery)was selected to have a stenosis degree of?95%.According to the Rentrop grading method,the patients were divided into CCC adverse group(Rentrop0~1 grade,n=48 cases)and CCC good group(Rentrop 2~3,n=52 cases).The SPSS22.0statistical software package was used for data analysis.The MedCalc software was used to describe the ROC curve to describe the influencing factors on the formation of CCC.Predict the value,calculate the area under the curve and the Yoden index.P<0.05 on both sides considered the difference to be statistically significant.Results:1.The selected patients successfully completed the emergency operation.Among them,48 patients had poor coronary collateral vessel filling,and the remaining 52patients had good coronary collateral vessels.2.Analysis of general clinical data of patients:Univariate analysis showed that the proportion of CCC with good diabetes was higher than that of non-diabetic CCC([61.2%vs.58.3%),P=0.047],the difference was apparently statistically significant.(P<0.05),There was no significant difference in other clinical data between the two groups.(P>0.05).3.Patient-related laboratory examination analysis results:Univariate analysis showed that CCC formed a poor group of homocysteine[12(10.25,13)umo/l vs.10(9,11)],creatine kinase co-work Enzyme[22.92(5.81,60.14)mmo/l vs.11.08(2.75,35.86)mmo/l]and platelet count[206(151.5,233.75)~*10~^9 vs.175.5(139.25,175.5)*10~^9]The peak concentration level was significantly higher than that of the well-formed CCC group,and the difference was statistically significant(P<0.05),while the other biochemical indicators were not statistically significant(P>0.05).4.The results of coronary angiography showed that the number of coronary artery lesions in poor CCC group was lower than that in good CCC group,that is,single vessel lesion[16 vs.9],double vessel lesion[15 vs.12],and three vessel lesions[17 vs.31].There was significant difference between the two groups(P<0.05),but there were no obviously significant differences in the left anterior descending,left circumflex,and right coronary lesions of the diseased vessels(P>0.05).5.The univariate analysis P<0.05 variable was brought into the multi-factor binary logistic regression analysis:Homocysteine(OR:2.099,95%CI:1.487~2.961;P<0.001),single vessel Lesions(OR:6.409,95%CI:1.595 to 25.754;P=0.009),it is speculated that homocysteine and coronary single-vessel disease are independent risk factors for CCC formation in STEMI patients.The results of ROC curve analysis showed that the optimal cutoff value of homocysteine for predicting poor CCC formation was11.0umol/l,the sensitivity was 58.3%,the specificity was 79.6%,and the area under the curve was 0.748(OR:2.210,95%CI:1.536 to 3.181;P<0.001).When the peak level of Hcy concentration exceeds 11.0 umol/l,collateral vessel formation can be predicted to be poor.Conclusion:1.Homocysteine may inhibit the formation of CCC,which is an independent risk factor for the formation of early coronary collateral circulation in patients with acute STEMI;creatine kinase isoenzymes,platelet count may inhibit the formation of CCC,and troponin I,Myoglobin,neutrophils,NT-proBNP,TG,HDL-c,LDL-c,serum creatinine,and blood uric acid had no significant effect on collaterals.2.Diabetes is not conducive to the formation of CCC in patients with acute STEMI,and the formation of collaterals is not obvious in gender,age,BMI,hypertension,hyperlipidemia.3.The number of vascular branches of coronary artery disease affects the formation of collaterals.The more lesions,the more favorable the formation of collateral vessels.Coronary single vessel disease is an independent risk factor for CCC formation.