侧支循环分级与急性心肌梗死机械并发症关联的研究进展

Research Progress on the Association between Collateral Circulation Grading and Mechanical Complications of Acute Myocardial Infarction

摘要: 急性心肌梗死(AMI)是临床常见的心血管急危重症。尽管再灌注治疗改善了患者预后，但机械并发症仍是导致死亡的重要原因之一。这类并发症虽不常见，却具有极高的死亡率，因此早期识别高危人群至关重要。侧支循环作为心肌缺血时的潜在代偿通路，其丰富程度可能直接影响机械并发症的发生风险。冠状动脉造影Rentrop分级是目前评估侧支循环最常用的方法。临床研究表明，侧支循环良好者心肌损伤更轻、心功能恢复更好，机械并发症风险较低；而侧支循环不良者风险较高。本文系统综述侧支循环分级对AMI后心肌的保护作用及其与三种主要机械并发症的关联，以期为临床早期预警提供参考。

Abstract: Acute myocardial infarction (AMI) is a common critical cardiovascular emergency. Although reperfusion therapy has improved patient outcomes, mechanical complications remain an important cause of death. Although these complications are uncommon, they are associated with extremely high mortality; therefore, early identification of high-risk individuals is crucial. As a potential compensatory pathway during myocardial ischemia, the extent of collateral circulation may directly influence the risk of mechanical complications. The Rentrop grading system of coronary angiography is the most commonly used method to evaluate collateral circulation. Clinical studies have shown that patients with well-developed collaterals suffer less myocardial injury, have better recovery of cardiac function, and have a lower risk of mechanical complications, whereas those with poor collaterals have a higher risk. This article systematically reviews the cardioprotective effects of collateral circulation grading after AMI and its association with the three main types of mechanical complications, aiming to provide a reference for early clinical warning.