Effect Of Coronary Artery Collateral Circulation Formation And The Degree Of Multi-factor Analysis

Objective: Clinical observation found that some symptoms of myocardial ischemia of coronary heart disease(CHD) patients with coronary artery stenosis degree is nonlinear relationship, For coronary artery disease patients with similar chronic total occlusion(CTO), the clinical manifestations of which often have bigger difference with each other. By further study with coronary angiography, it had been found that this may be closely related to whether there was a good collateral circulation.There were many factors affecting the formation of collateral circulation. Study at home and abroad showed that the extent of coronary stenosis, endothelial growth factor and some relaxation factors and moderate exercise all could promote collateral circulation formation. However, the influence of clinical characteristics of patients(including gender, age, hyperlipidemia, hypertension, smoking, obesity, diabetes) and Prior history of coronary heart disease(including Myocardial infarction, angina pectoris) on the formation of collateral circulation are still lack of consensus. In this study, we investigated the relationship between coronary artery lesion characteristics, risk factors for CHD, Prior history of CHD and collateral circulation formation, and the influence of coronary artery lesion characteristics, risk factors for CHD, Prior history of CHD on collateral circulation maturity. Meanwhile, we found the factors promoting coronary collateral circulation formation, and provide theoretical basis for medical treatment of patients with diffuse severe coronary artery stenosis.Methods: 268 CHD inpatients(more than one main branch of coronary with stenosis degree greater than or equal to 50% by coronary angiography) were enrolled from September 2013 to July 2014.According to the results of coronary angiography(with or without collateral circulation), patients were divided into two groups: CCC group and non-CCC group. Then collateral maturity was evaluated by Rentrop method, and CCC group was divided into three groups: CC1, CC2, CC3. Level 2 and 3 mean that the judgment of collateral circulation was good, level 1 mean that judgment was bad. Detailed history, pre-hospital medical situation, relevant inspection and general information were conducted after admission. Angiogram and document imaging results with or without coronary collateral circulation and its levels were carefully reviewed and collected during intraoperative and postoperative. SPSS 17.0 was used for correlation analysis among coronary artery lesion characteristics, risk factors for CHD, Prior history of CHD and collateral circulation formation.Results:(1) CCC group rate of coronary multi-vessel lesions(84.3%) and stenosis was significantly higher than that of without CCC group(56.6%), the difference was statistically significant. Coronary artery stenosis with CCC group were over 95%, there is a 94.3% occlusion or functional block. But the lesion counts in CC1, CC2, CC3 there was no significant difference in three groups, P > 0.05).(2) CCC group and no CCC group has significant difference in smoking(P < 0.05), in gender, age, BMI, TC, LDL were no significant differences(P > 0.05); In CC1, CC2, CC3 three groups had no significant difference, P > 0.05).(3) Suffering from angina pectoris, myocardial infarction in proportion with CCC and no CCC group were 88.57%vs67.17%,45.7%vs26.8%,significant difference between two groups, P < 0.05; Suffer from diabetes, high blood pressure and its course in the CCC group and no CCC group, no significant difference between P > 0.05; In CC1, CC2, CC3 three groups had no significant difference, P > 0.05).(4)Subgroup analysis with CCC group of patients, the majority of coronary collateral, LAD, the proportion of LCX, RCA as blood supply are 34.83%, 30.33% and 34.83% respectively, there was no statistically significant difference(P > 0.05; As the blood of the proportion is 32.05%, 23.08% and 48.71% respectively, the difference was statistically significant P < 0.05, indicating higher rates RCA occlusion; Analysis of blood according to the source, RCA occlusion, blood supply for the LAD, the proportion of LCX basic equal; LCX and LAD occluded lesion occurs, the vast majority of blood supply for RCA.Conclusion:(1)Coronary artery stenosis degree and the lesion count is closely related to the formation of collateral circulation, the lesion counts more many more easy as collateral circulation, the formation of collateral circulation were built on the basis of coronary artery of severe stenosis(95% or higher);(2) Patients with a history of myocardial infarction and angina more prone to coronary collateral circulation formation, and the extension of myocardial infarction, course of collateral circulation establishment rate increases, but had no effect on the maturity of collateral circulation;(3) Smoking inhibit the formation of collateral circulation, but no obvious related with the maturity of collateral circulation;(4) Coronary heart disease risk factors in age, sex, hyperlipidemia, body mass index, diabetes, high blood pressure and risk of angina pectoris and the formation of collateral circulation and maturity are no significant correlation;(5)Subgroup analysis right coronary occlusion rate is higher also easy formation of collateral circulation, for the most part coronary collateral circulation in coronary artery.