| Objective:This research discussed the influencing factors of coronary collateral circulation in patients with severe coronary artery stenosis and non-ST-segment elevation myocardial infarction by analysising the clinical data and features of coronary angiography.Materials and Methods:The study included 104 patients who admitted to the cardiology department of Liao Ning provincial people's hospital with non-ST-segment elevation myocardial infarction from september 2017 to july 2019.Selective coronary angiography was performed during hospitalization,and the results showed at least one major coronary artery stenosis ?90% or occlusion.Coronary collateral circulation(CCC)was evaluated by coronary angiography.CCC grading criteria were used Rentrop-Cohen coronary collateral circulation grading.The patients were divided into two groups: A group was a poorly developed CCC(CCC grade 0-1,n=40),B group was a well-developed CCC(CCC grade 2-3,n=68).Of these,there were 20 patients with CCC grade 0,20 patients with CCC grade 1,40 patients with CCC grade 2,28 patients with CCC grade 3.1.The retrospective study was to collect clinical data of the 104 patients,including: age,gender,history of smoking,history of hyperlipidaemia,history of diabetes,medication use,blood glucose(GLU),creatinine(Cr),triglyceride(TG),cholesterol(CG),lipoprotein(LP-a),uric acid(UA)and so on and analyzing coronary angiography characteristics: coronary lesion site,coronary lesion count,coronary stenosis degree and Coronary artery Gensini score.Firstly,single factor analysis was conducted on the influence of CCC formation,Secondly,we used logistic regression analysis to assess the influencing factors of statistical significance.2.To further analyze the independent factors affecting the formation of coronary collateral circulation in patients with acute NSTEMI,The difference of serum LP-a concentration between the group with poorly developed CCC(CCC grade 0-1)and the group with well-developed CCC(CCC grade 2-3)was compared.Then we analyzed the relation between the CCC grade and LP-a concentration by spearman correlation analysis.Results:1.The 104 patients were divided into two groups: A group was a poorly developed CCC(CCC grade 0-1,n=40),B group was a well-developed CCC(CCC grade 2-3,n=68).After univariate analysis of clinical data between the two groups showed that Cr(P=0.038),CG(P=0.036),LDL-c(P=0.035)and LP-a(P=0.000)were associated with formation of CCC significantly.(P<0.05).The difference in the Coronary artery Gensini score(P=0.000)between the groups was significant(P < 0.05).2.Significant variables were analyzed by single factor analysis,including Cr(P=0.038),CG(P=0.036),LDL-c(P=0.035),LP-a(P=0.000),and Coronary artery Gensini score(P=0.000).The significant variables of univariate analysis,including Cr(P=0.038),CG(P=0.036),LDL-c(P=0.035),LP-a(P=0.000),and Coronary artery Gensini score(P=0.000),were analyzed by multivariate Logistic regression.The results showed that LP-a and Coronary artery Gensini score were independent influencing factors of CCC formation.3.In the relationship between the location of coronary artery stenosis and formation of CCC,the present rate of the formation of CCC on patients who had left or right coronary artery as the ischemia-related vessels was66.1%(41/62)and 49.0%(47/96),the rate of well-developed CCC was59.7%(37/62)and 32.3%(31/96)respectively.The location of coronary artery lesion was significantly relative to prevalence and the degree of the CCC,the present rate and degree of CCC about the arteriostenosis on right coronary artery were higher than those on the left coronary artery.4.The difference of serum LP-a concentration between the poorly developed CCC and the well-developed CCC was statistically significant(P< 0.05),poorly developed CCC(184.64 + 55.62 mg/L)is significantly higher than well-developed CCC(99.37 + 69.48 mg/L);The CCC was divided into four groups,and the serum LP-a concentration was also divided into four groups.It was found that the LP-a concentration decreased with the increase of CCC grade,Spearman analysis showed(r=-0.683,P=0.000),serum LP-a concentration and CCC grade was negatively correlated.Conclusions:In the patients with acute NSTEMI and accompanied severe coronary artery stenosis:1.LP-a levels and Coronary artery Gensini score were independent influencing factors of CCC formation.2.Serum Lp-a levels inhibited the formation of CCC,and serum LP-a levels and CCC grade was negatively correlated.3.The location of coronary artery lesion was significantly relative to prevalence and the degree of the CCC,the present rate and degree of CCC about the arteriostenosis on right coronary artery were higher than those on the left coronary artery. |
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