Predictors Of Poor Collateral Circulation In Patients With Acute Myocardial Infarction

Objective:To study the influence of clinical factors on the development of Coronary Collateral Circulation in patients with acute myocardial infarction,and to explore the predictive value of clinical factors on adverse Coronary Collateral Circulation(CCC).Methods:In this study,a retrospective study was used to collect the Coronary Artery angiography(CHT)treated in the Department of Cardiology of the First People’s Hospital of Qujing City from May 2019 to December 2020.CAG)showed that 216 patients with acute myocardial infarction(mean age 62.27±10.94 years old,168 males and 48 females)had at least one of the three main coronary arteries(right coronary artery,circumventing branch and anterior descending branch)with 100%degree of stenosis(complete occlusion).The general clinical base of patients was recorded in detail in the list,including gender,age,smoking history,alcohol consumption history,history of hypertension,history of diabetes and common laboratory indicators of patients enrolled.Including blood lipids(triglycerides,total cholesterol,HDL,LDL,lipoprotein A,homocysteine,uric acid,high-sensitivity C-reactive protein,blood routine(white blood cell count,platelet count,neutrophils,lymphocyte count),At the same time,new inflammatory markers(lymphocyte to monocyte ratio,platelet to lymphocyte ratio,neutrophils to lymphocyte ratio)and other related laboratory indicators were calculated and recorded.Then two experienced interventionists interpreted the results of coronary angiography,and recorded the lesion vessels,number of branches,degree of stenosis and growth of collateral vessels in detail.The development of coronary collateral circulation in 216 enrolled patients was classified according to the Coen-Rentrop method,with grade 0=no collateral vessels supplying the infarted area;Grade 1=Collateral vessels can be seen in the infarct area,but not in the epicardial region;Grade 2=angiography showing the epicardial segment of vessels with partial collateral filling;Grade 3=The epicardial artery is strongly filled with collateral vessels.According to the results of angiography,the group with poor collateral circulation growth(151 cases)was classified as grade 0-1 collateral circulation,and the group with grade 2-3 collateral circulation was classified as good collateral circulation(65 cases)by Rentrop evaluation.After the data of all patients were collected,Excel tables were created to organize the data.SPSS 25.0 statistical software was used to analyze the statistical data.Univariate analysis was initially adopted,and the significant influencing factors in univariate analysis(P<0.05)were included in multivariate binary Logistic regression analysis for statistical analysis without confounding factors,and the effects of various clinical factors on collateral circulation development were compared respectively.Receiver operating curve(ROC curve)was drawn for the independent influencing factors evaluated as coronary collateral dysplasia.To evaluate the value of related clinical factors in predicting poor collateral circulation in patients with acute myocardial infarction.Results:1.A total of 216 eligible patients with acute myocardial infarction were included in this study and CCC was assessed according to the Rentrop grade after coronary angiography.Of these,151 patients were rated as having developed CCC and 65 had good developed CCC.2.In terms of basic clinical characteristics,statistical analysis showed that the distribution of general clinical data in the CCC dysplasia group and the well-developed CCC group of patients included in the study were as follows:Gender(male/female ratio,73.5%/26,5 VS 87.7/12.3%,p=0.021),age(61.18±11.07 years old VS 63.35± 10.81 years old,p=0.184),smoking history(48.3%VS 52.3%,p=0.593),hypertension(69.5%VS 55.4%,p=0.045),diabetes(38.4%VS 21.5%,p=0.016).According to the statistical data,in terms of basic clinical characteristics,gender,history of hypertension and history of diabetes were significantly different between the CCC stunted group and the good group(p<0.05).3.The statistical analysis of laboratory indicators showed that the differences between the CCC stunted group and the good group were statistically significant laboratory indicators:LP-A(379.47±353.67 VS 244.32±376.34,p=0.012),Hcy(19.07±12.04 VS 11.06±3.14,p=0.001),hs-CRP(3.03±3.18 VS 1.69±2.94,p=0.004),LMR(2.24±0.87 VS 1.30±0.26,p=000),NLR(2.24±0.87 VS 1.30±0.26,p=0.000),(p<0.05).and there was no significant difference in TG,TC,LDL-C,HDL-C,UA,WBC,PLT and PLR between the two groups.4.The number of coronary artery lesions(multi-vessel lesions:72.3%VS 87.7%,p=0.013,higher in the well-developed group),occluded vessels(RCA occluded:37(56.9%)VS 54(35.8%),p=0.004,which accounted for a higher proportion in the well developed group,much higher than the occlusion of LCX(21.5%)and LAD(21.5%)in the good CCC group.5.Multivariate binary Logistic regression analysis of factors with statistically significant differences between the poor collateral circulation group and the good collateral circulation group in univariate analysis showed that gender,diabetes,hs-CRP and LMR showed no statistically significant differences between the poor collateral circulation group and the good collateral circulation group after the exclusion of confounding factors.However,hypertension(OR=0.312,95%confidence interval 0.103-0.948,p=0.040),LP-A(OR=1.003,95%confidence interval 1.001-1.004,p=0.003),Hcy(OR=1.169,95%confidence interval 1.052-1.300,p=0.004),NLR(OR=59.250,95%confidence interval 13.878-252.954,p=0.000),RCA occlusion(OR=0.246,95%confidence interval 0.089-0.680,p=0.007)was an independent risk factor for collateral dysplasia in AMI patients.6.The ROC curve was drawn for the independent risk factors for dysplastic collateral circulation in patients with AMI,and the area under the curve for predicting dysplastic CCC in LP-A was 0.702(95%confidence interval 0.622-0.782,p=0.000).The best cutoff value was 251.5mg/L,the sensitivity was 61.6%,and the specificity was 72.3%.The area under the curve predicted by Hcy for CCC dysplastic development was 0.614(95%confidence interval 0.540-0.689,p=0.008),the best cutoff value was 21.5 umol/L,the sensitivity was 25.8%,and the specificity was 100%.The area under the NLR curve for predicting CCC stunting was 0.893(95%confidence interval 0.899-0.937,p=0.000),with an optimal cut-off value of 1.455,a sensitivity of 78.1%,and a specificity of 86.2%.These results indicate that LP-A,HCY and NLR have good predictive value for CCC dysplasia.NLR has good sensitivity and specificity for the prediction of CCC dysplasia.Conclusions:1.The proportion of well-developed CCC in AMI patients was 30.1%;2.Gender,hypertension,diabetes,LP-A,Hcy,LMR,NLR,hs-CRP,multi-vessel coronary artery disease,and RCA occlusion all affect the development of CCC in AMI patients.3.Hypertension,LP-A,Hcy,NLR and RCA occlusion were independent risk factors for CCC development in patients with clinical AMI.4.Hypertension is a protective factor for the development of CCC in patients with acute myocardial infarction.5.The best cutoff value of LP-A for predicting CCC dysplasia in AMI patients was 251.5mg/L.High serum LP-A level was adverse to the formation of CCC,and it was an effective predictor of CCC dysplasia.6.The best cutoff value of Hcy for predicting CCC dysplasia in AMI patients was 21.5umol/L,and Hcy had a good sensitivity for predicting CCC dysplasia.7.NLR has good sensitivity and specificity for predicting CCC dysplasia in AMI patients,and has certain predictive value for CCC dysplasia.The best cutoff value is 1.455.