冠状动脉慢性完全闭塞病变侧支循环的预测因素和预后意义

于子翔; 董佳佳; 赵龙; 杨毅宁; 李晓梅; 迪拉热·阿迪; 丁欣; 马依彤

doi:10.13201/j.issn.1001-1439.2021.08.005

冠状动脉慢性完全闭塞病变侧支循环的预测因素和预后意义

- 新疆医科大学第一附属医院心脏中心冠心病一科(乌鲁木齐, 830054)
基金项目:
新疆维吾尔自治区重点实验室开放课题(No:2020D04008)

详细信息

通讯作者: 马依彤,E-mail:myt-xj@163.com

中图分类号: R543.3

收稿日期: 2021-01-31

Predictors and prognostic significance of good collateral circulation in patients with coronary chronic total occlusion

- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China

More Information

Corresponding author: MA Yitong, E-mail: myt-xj@163.com

Received Date: 31 January 2021

摘要

摘要: 目的:在冠状动脉慢性完全闭塞病变(CTO)中,侧支循环的相关预测因素及侧支循环对患者的预后影响目前尚不清楚。本研究试图通过相关预测因素进一步推断冠状动脉侧支循环的成熟度,同时进一步探讨侧支循环对于患者预后的影响。方法:纳入2016年10月—2019年12月在新疆医科大学第一附属医院心脏中心接受经皮冠状动脉介入治疗(PCI)的CTO患者,根据Rentrop分级标准对患者的侧支循环情况进行评估,分为侧支循环良好组(Rentrop 2~3级,168例)和侧支循环不良组(Rentrop 0~1级,135例)。比较两组患者的临床资料,采用多因素logistic回归分析影响CTO患者冠状动脉侧支循环形成的因素,采用Kaplan-Meier生存曲线分析及多因素Cox回归分析探讨侧支循环良好组和不良组主要不良心脑血管事件(MACCE)的发生率是否有差异。结果:侧支循环不良组与良好组临床资料差异无统计学意义;侧支循环不良组中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞百分比均高于侧支循环良好组(均P<0.05)。多因素logistic回归分析显示,影响侧支循环形成的独立危险因素包括NLR(OR:0.434,95%CI:0.310~0.607;P<0.001)与Gensini评分(OR:0.992,95%CI:0.895~0.998;P<0.012)。随访15(10~33)个月,侧支循环良好组与不良组MACCE差异无统计学意义(14.1%∶13.7%,P=0.928)。结论:在CTO患者中,NLR升高是侧支循环不良的独立危险因素。侧支循环成熟度对于CTO患者的预后无显著影响。
- 冠状动脉慢性完全闭塞病变 /
- 侧支循环 /
- 预后
Abstract: Objective: In patients with chronic total occlusion(CTO), the predictors of coronary collateral circulation(CCC) and its effect on prognosis are still unclear. This study attempts to infer the maturity of CCC through related predictors and explore the impact of CCC on the prognosis.Methods: Patients with CTO who underwent percutaneous coronary intervention(PCI) in the heart center of the First Affiliated Hospital of Xinjiang Medical University from October 2016 to December 2019 were included. The Rentrop grade system was utilized to clarify the collateral vessels and all patients were divided into a good-CCC group(Rentrop 2-3, n=168) and poor-CCC group(Rentrop 0-1, n=135). The clinical data between the two groups were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of CCC. Kaplan-Meier survival curve and multivariate Cox regression were used to explore whether there was a difference in the incidence of major adverse cardiovascular and cerebrovascular events(MACCE) between the good-CCC group and poor-CCC group.Results: There was no significant difference in clinical data between the poor-CCC group and the good-CCC group. The ratio of neutrophils to lymphocytes(NLR) and neutrophils in the poor-CCC group was higher than those in the good-CCC group(both P<0.05). Multivariate logistic regression analysis showed that NLR(OR: 0.434, 95%CI: 0.310-0.607; P<0.001) and Gensini score(OR: 0.992, 95%CI: 0.895-0.998; P<0.012) were independent predictors for CCC. All patients were followed up for 15(10, 33) months, there was no significant difference in MACCE between the good-CCC group and the poor-CCC group(14.1% vs. 13.7%, P=0.928).Conclusion: In patients with CTO, increased NLR is an independent predictor for poor collateral circulation, and CCC maturity has no significant effect on the prognosis.
- chronic total occlusion /
- collateral circulation /
- prognosis

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参考文献(22)

[1]	Di Mario C,Werner GS,Sianos G,et al.European perspective in the recanalisation of Chronic Total Occlusions(CTO):consensus document from the EuroCTO Club[J].EuroIntervention,2007,3(1):30-43.
[2]	Sianos G,Werner GS,Galassi AR,et al.Recanalisation of chronic total coronary occlusions:2012 consensus document from the EuroCTO club[J].EuroIntervention,2012,8(1):139-145.
[3]	Tomasello SD,Boukhris M,Giubilato S,et al.Management strategies in patients affected by chronic total occlusions:results from the Italian Registry of Chronic Total Occlusions[J].Eur Heart J,2015,36(45):3189-3198.
[4]	Râmunddal T,Hoebers LP,Henriques JP,et al.Chronic total occlusions in Sweden--a report from the Swedish Coronary Angiography and Angioplasty Registry(SCAAR)[J].PLoS One,2014,9(8):e103850.
[5]	Claessen BE,van der Schaaf RJ,Verouden NJ,et al.Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention[J].JACC Cardiovasc Interv,2009,2(11):1128-1134.
[6]	李小峰,王玺,卢文杰,等.冠状动脉慢性完全闭塞患者纤维蛋白原/白蛋白比值与冠状动脉侧支循环形成的关系[J].河南医学研究,2020,29(4):589-592.
[7]	Seiler C,Stoller M,Pitt B,et al.The human coronary collateral circulation:development and clinical importance[J].Eur Heart J,2013,34(34):2674-2682.
[8]	Rampidis GP,Benetos G,Benz DC,et al.A guide for Gensini Score calculation[J].Atherosclerosis,2019,287:181-183.
[9]	林曙光.2014心脏病学进展[M].北京:人民军医出版社,2014:288-291.
[10]	Elkind MS,Cheng J,Boden-Albala B,et al.Elevated white blood cell count and carotid plaque thickness:the northern manhattan stroke study[J].Stroke,2001,32(4):842-849.
[11]	Turak O,Ozcan F,Isleyen A,et al.Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis[J].Am J Cardiol,2012,110(10):1405-1410.
[12]	RS H,IE K.The pathophysiology and treatment of sepsis.[J].New Engl J Med,2003,348(2):138-150.
[13]	Imhof BA,Aurrand-Lions M.Angiogenesis and inflammation face off[J].Nat Med,2006,12(2):171-172.
[14]	Turkmen K,Tufan F,Selçuk E,et al.Neutrophil-to-lymphocyte ratio,insulin resistance,and endothelial dysfunction in patients with autosomal dominant polycystic kidney disease[J].Indian J Nephrol,2013,23(1):34-40.
[15]	la Sala A,Pontecorvo L,Agresta A,et al.Regulation of collateral blood vessel development by the innate and adaptive immune system[J].Trends Mol Med,2012,18(8):494-501.
[16]	Kalay N,Dogdu O,Koc F,et al.Hematologic parameters and angiographic progression of coronary atherosclerosis[J].Angiology,2012,63(3):213-217.
[17]	Tamhane UU,Aneja S,Montgomery D,et al.Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome[J].Am J Cardiol,2008,102(6):653-657.
[18]	Werner GS.The role of coronary collaterals in chronic total occlusions[J].Curr Cardiol Rev,2014,10(1):57-64.
[19]	Toma A,Stähli BE,Gick M,et al.Comparison of benefit of successful percutaneous coronary intervention for chronic total occlusion in patients with versus without reduced(≤40%)left ventricular ejection fraction[J].Am J Cardiol,2017,120(10):1780-1786.
[20]	Jang WJ,Yang JH,Choi SH,et al.Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation[J].JACC Cardiovasc Interv,2015,8(2):271-279.
[21]	畅晓燕,赵江峰.经皮冠状动脉介入治疗慢性完全闭塞病变对患者心脏功能的影响[J].临床心血管病杂志,2021,37(3):220-223.
[22]	Werner GS,Victoria MY,David HS,et al.A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions[J].Eur Heart J,2018(26):457.