| Introduction:In coronary artery disease patients with severe coronary artery stenosis, the formation of coronary collateral circulation (CCC) can reduce major adverse cardiovascular events, improve the function of the ischemic myocardium and prognosis of the patients. But, recently, some scholars have showed that CCC is a high risk factor for restenosis. CCC can even increase mortality of patients with acute coronary syndrome (ACS). Meanwhile, the development of CCC was influenced by many factors. Among the influencing factors, the classic ones were researched more, such as diabetes, hypertension, smoking, age and so on. There were still many arguments but no clear conclusion.Objective:This research discusses the influencing factors of CCC in the patients with severe coronary artery stenosis and acute coronary syndrome by analyzing the clinical data, and discuss the influence of CCC on the short-term prognosis of patients with ACS and severe coronary artery stenosis. The objective of this research is to show it’s mechanism.Method:1. We studied 315 consecutive patients who were admitted to the First Affiliated Hospital of Soochow University with acute coronary syndrome, from March 2010 to June 2013. According to angiographic estimation, Total 315 patients with stenosis of one vessel≥90%, among three main vessels of coronary artery, were enrolled in the study. Development of CCC was classified by Rentrop method. According to the collateral degree, the patients were divided into two groups:a) Non-CCC formation group-191 patients with CCC grade 0; b) CCC formation group-124 patients with CCC grade 1-3.2. The retrospective study was to collect clinical data of enrolled patients, such as age, gender, history of diabetes, history of hyperlipidemia, history of smoking, acute myocardial infarction and so on. We assessed the relationship between the formation of CCC and influencing factors by means of univariate analysis.3. We used logistic regression analysis to assess the influencing factors of statistical significance by means of univariate analysis, and draw a conclusion of independent influencing factors that influence the development of CCC.4. The result between the two groups was compared. The outcomes were divided into 5 types:(1) cardiogenic shock;(2) heart failure;(3)cardiac rupture including ventriculus sinister free wall rupture and ventricular septal rupture;(4) malignant arrhythmia; (5) ventricular aneurysm.Results:1.315 patients were enrolled, including CCC formation group (CCC grade 1-3) and non-CCC formation group (CCC grade 0). After univariate analysis of clinical data, age, age of>65 years, history of diabetes, history of smoking, creatinine and acute myocardial infarction were associated with formation of CCC significantly. (P<0.05)2. After multivariate logistic regression analysis of influencing factors of statistical significance, history of smoking and acute myocardial infarction were independent influencing factors of CCC formation (P<0.05)3. Patients in CCC formation group had a significantly higher incidence of cardiogenic shock, compared with those in non-CCC formation group(P<0.05).Two groups were similar in the incidence of heart failure, cardiac rupture and ventricular aneurysm. Compared with those in non-CCC formation group, Patients in CCC formation group had a significantly lower incidence of malignant arrhythmia (P<0.05).Conclusion:1. Smoking was positively correlated with CCC formation in the patients with severe coronary artery stenosis and acute coronary syndrome.2. Among the patients with severe coronary artery stenosis and acute coronary syndrome, more CCC was developed in the patients with acute myocardial infarction than in the patients with angina.3. CCC reduced the occurrence of malignant arrhythmia in patients with ACS and severe coronary artery stenosis, but did not affect the occurrence of heart failure, cardiac rupture and ventricular aneurysm. Also the presence of CCC was associated with increased incidence of cardiogenic shock. |
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