ANGIOGRAPHIC EVOLUTION OF CORONARY-ARTERY MORPHOLOGY IN UNSTABLE ANGINA
ANGIOGRAPHIC EVOLUTION OF CORONARY-ARTERY MORPHOLOGY IN UNSTABLE ANGINA
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DOI：
10.1016/s0735-1097(86)80455-7
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发表时间：
1986-03-01
影响因子：
24
通讯作者：
FUSTER, V
中科院分区：
文献类型：
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作者：
AMBROSE, JA;WINTERS, SL;FUSTER, V
如先前在不稳定型心绞痛的急性表现中所报道的，在冠状动脉造影中约70%的病例中发现了可识别的特征性冠状动脉病变。由于一个或多个突出边缘或不规则的扇形边界或两者兼而有之，这表现为偏心放置的凸形狭窄，颈部狭窄。为了研究不稳定型心绞痛病变的演变，对进展为不稳定型心绞痛的稳定型心绞痛患者的冠状动脉解剖和血管造影形态进行了评价。I组包括25例稳定型心绞痛病史的患者，他们在急性不稳定型心绞痛发作后重新研究，II组包括21例导管插入术之间症状变化很小或没有变化的患者。I组25例患者中有19例（76%）发生冠状动脉疾病进展，而II组21例患者中有7例（33%）发生冠状动脉疾病进展（p < 0.001）。在第I组的25处进展病变中，17处进展至小于100%，8处进展至100%闭塞。第I组的这25处病变中有18处以前不明显（第一次导管插入时闭塞< 50%）。相比之下，在第II组的8处疾病进展病变中，只有2处之前不显著，而6处在初始研究中显示至少50%闭塞。在第I组中，71%的进展至小于100%闭塞的所有病变中观察到偏心性病变，但在任何第II组进展血管中均未观察到偏心性病变。因此，疾病进展在不稳定型心绞痛的急性表现中非常常见，并且大多数病变从先前不显著的狭窄进展。由于一个或多个突出边缘或不规则的扇形边界或两者兼而有之而导致的偏心性病变伴窄颈，是此类进展中冠状动脉病变的最常见构型，似乎是不稳定型心绞痛的主要原因。
As previously reported in acute presentations of unstable angina, an identifiable characteristic coronary artery lesion has been found in about 70% of cases at coronary arteriography. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. To study the evolution of lesions responsible for unstable angina, coronary artery anatomy and morphology on angiography were evaluated in patients with stable angina progressing to unstable angina. Group I comprised 25 patients with a history of stable angina who were restudied after an acute episode of unstable angina and Group II comprised 21 patients with little or no change in symptoms between catheterizations. Progression of coronary disease occurred in 19 (76%) of 25 patients in Group I compared with 7 (33%) of 21 in Group II (p < 0.001). Of the 25 lesions with progression in Group I, 17 progressed to less than 100% and 8 to 100% occlusion. Eighteen of these 25 lesions in Group I were previously insignificant (< 50% occlusion on the first catheterization). In contrast, of the eight lesions with disease progression in Group II, only two were previously insignificant while six showed at least 50% occlusion on the initial study. The eccentric lesion was seen in 71% of all lesions with progression to less than 100% occlusion in Group I, but it was not seen in any Group II vessel with progression. Therefore, progression of disease is very common in acute presentations of unstable angina and most lesions progress from previously insignificant stenoses. An eccentric lesion with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both, is the most common configuration of coronary lesions in this type of progression and it appears to be a major cause of unstable angina.