| Objective:To research the clinical significance of lipoprotein(a)[Lp(a)]and C-reactive protein(CRP)on the formation of coronary collateral circulation(CCC)in patients with acute myocardial infarction(AMI).Methods: A retrospective analysis was conducted to select 248 patients who were admitted to the Department of Cardiology of the Jiangsu North People‘s Hospital,diagnosed with acute myocardial infarction for the first time and underwent primary percutaneous coronary intervention from July 2017 to July 2018.All patients were stratified into two groups according to the the results of coronary angiography and Rentrop scoring system: Rentrop scores 0 and 1 were classified as poor collateral circulation group(n=138),Rentrop scores 2 and 3 were classified as good collateral circulation group(n=110).All patients underwent venous blood sampling coll ection before surgery,and their medical history,clinical basic data and laboratory indicators were recorded in detail.The serum Lp(a)and CRP concentrations were determined by immunoturbidimetric assay,and then the Lp(a)and CRP concentrations between the two groups were compared.Statistical analysis was performed using statistical software package SPSS23.0.Independent sample t-test and chi-square test were used for comparison between groups.Multivariate analysis was performed by logistic regression analysis.Spearman correlation analysis was used to examine the association between Rentrop grading and Lp(a)and CRP in patients with AMI.Lp(a)and CRP were used to predict the receiver operating characteristic curve(ROC)of collateral formation in patients with AMI,and the area under curve(AUC)was calculated.All tests were statistically significant at p<0.05.Result:Compared with the poor CCC group and the good CCC group,the univariate analysis of the two groups of AMI patients showed that gender,age,BMI,smoking history,systolic blood pressure,history of hypertension,hemoglobin content,hematocrit,mean red blood cell volume,monocyte,red blood cell distribution width,fasting blood glucose,glycosylated hemoglobin,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol and triglyceride have no statistical significance(All P>0.05).There was no significant difference in infarct-related artery(LAD,LCX or RCA)and number of diseased vessels(single,double,and triple)between the CCC-producing group and the CCC-producing group(P>0.05).Lp(a)(187.01±33.15 VS 151.29±39.82 mg/L),CRP(14.54±5.43 VS 12.20±4.58 mg/L),Diabetes(36.2% VS 24.5%),diastolic blood pressure(76.32±13.05 VS 79.37±10.74 mmHg),pre-infaction angina(20.3% VS 35.5%)were statistically significant(All P <0.05).The Lp(a)levels,CRP levels,and diabetes prevalence in the poor CCC group were significantly higher than those in the good CCC group.The diastolic blood pressure and pre-infarction angina prevalence was significantly lower in the poor CCC group than in the good CCC group.The differences between the two groups were statistically significant(All P<0.05).Spearman correlation analysis showed that serum Lp(a)levels were negatively correlated with CCC grade(r=-0.446,P < 0.001),and CRP levels were negatively correlated with CCC grade(r=-0.257,P <0.001).Multivariate logistic regression analysis showed that serum Lp(a)levels(OR= 1.025,P< 0.001),CRP levels(OR= 1.069,P= 0.027),pre-infarction angina prevalence(OR= 0.508,P= 0.042)and diabetes history(OR= 2.364,P= 0.008)were closely related to the CCC generate adverse and are found to be independent predictors of poor CCC.There was no statistical difference in diastolic blood pressure in Logistic regression analysis.The results of ROC curve analysis of Lp(a)and CRP concentrations in predicting coronary collateral circulation in patients with AMI showed that Lp(a)and CRP concentrations were estimated to be 81.9%,73.9%,and specificity were 70.0% and 54.5%.The combined detection of Lp(a)and CRP increased the predicted CCC.The sensitivity of the combined detection in predicting poor formation was 84.1%,and the difference was statistically significant(P<0.05).Conclusion: 1.Pre-infarction angina pectoris is favorable factors for the formation of good collateral circulation in patients with acute myocardial infarction.Diabetes is not conducive to the formation of collateral circulation in patients with acute myocardial infarction.2.Lp(a)and CRP are associated with the formation of poor collateral circulation in acute myocardial infarction.And the level of Lp(a)and CRP was negatively correlated with the CCC grading.High levels of serum Lp(a)and CRP are independent predictors of poor CCC formation in patients with acute myocardial infarction.3.Lp(a)and CRP concentrations were estimated to be 81.9%,73.9%,and specificity were 70.0% and 54.5%.The sensitivity of two indicators were combined to predict CCC poor formation was increased to 84.1%,which can more accurately predict the poor formation of CCC in patients with AMI. |
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