老年急性心肌梗死患者梗死相关动脉侧支循环减少

作     者：Kurotobi T. Sato H. Kinjo K. 王亭忠 

作者机构：Dept. of Int. Med. and Thera peutics Osaka Univ. Grad. School of Medicine Suita JapanDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第1期

页      面：37-38页

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：梗死相关动脉 侧支循环 急性心肌梗死 冠脉造影检查 梗死前心绞痛 心绞痛病史 新生血管形成 血管生成因子 动物实验 促发 

摘      要：Objectives The purpose of this study was to investigate the hypothesis that ci rculation via collateral vessels to an infarctrelated artery (IRA) is impaired w ith aging in patients with acute myocardial infarction (AMI). Background Animal experiments have shown that advanced age blunts the development of new vessels i n response to angiogenic cytokines. Methods Of 3,573 consecutive patients with A MI, 1,934 patients who fulfilled the following criteria were enrolled in this st udy: 1) coronary angiograms were obtained within 72 h after the onset of AMI; an d 2) IRA showed complete occlusion (Thrombolysis In Myocardial Infarction flow grade 0 or 1). Collaterals to the IRA were angiographically evaluated usin g the Rentrop score. Rentrop scores 1 to 3 were defined as demonstrating significant collaterals. Results The prevalence of collaterals decreased with age, from 47.9%, 45.8%, 43.4%, to 34.0%in patients 50 years, 50 to 59 year s, 60 to 69 years, ≥70 years, respectively (p 0.001). Advanced age was an ind ependent factor predicting the absence of collateral circulation to the IRA. In contrast, time to catheterization, history of angina pectoris, and preinfarction angina were independent predictors for the presence of collaterals. Multivariat e analysis showed that the absence of collaterals was an independent predictor o f in-hospital mortality in elderly patients ≥70 years (odds ratio, 15.6; 95%c onfidence interval, 3.5 to 69.6), although this finding was not significant in p atients 70 years. Conclusions Advanced age is associated with decreased angiog raphic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.