ANGIOGRAPHIC PROGRESSION OF CORONARY-ARTERY DISEASE AND THE DEVELOPMENT OF MYOCARDIAL-INFARCTION
ANGIOGRAPHIC PROGRESSION OF CORONARY-ARTERY DISEASE AND THE DEVELOPMENT OF MYOCARDIAL-INFARCTION
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DOI：
10.1016/0735-1097(88)90356-7
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发表时间：
1988-07-01
影响因子：
24
通讯作者：
FUSTER, V
中科院分区：
文献类型：
--
作者：
AMBROSE, JA;TANNENBAUM, MA;FUSTER, V
在冠状动脉疾病进展为心肌梗死的患者中，很少有冠状动脉造影解剖的数据。在这项回顾分析中，描述了38名患者在两次心导管术之间冠状动脉疾病的进展情况：23名患者(I组)在两次研究之间发生了心肌梗死，15名患者(II组)在第二次研究中出现了一个或多个新的完全闭塞，但没有发生介入性脑梗塞。再研究时，I组与梗塞相关动脉的初始血管造影显示的狭窄程度中位数显著低于II组(48%比73.5%，p<；0.05)。在I组的梗塞相关动脉中，23个病变中只有5个(22%)最初为70%，而在II组中，18个病变进展为完全闭塞中的11个(61%)最初为>；70%(p<；0.01)。在I组中，发生Q波梗塞的患者在随后的梗塞相关动脉的初始血管造影术中(34%)比发生非Q波梗塞的病人(80%)的狭窄程度要轻(p<；0.05)。对第一组患者初次血管造影时的血管造影和临床特征进行的单变量和多变量分析显示，近端病变位置是病变演变的唯一重要预测因子。50%为脑梗塞。这项回顾性研究表明，心肌梗死通常是从以前不严重的病变发展起来的。此外，根据第一次冠状动脉造影的分析，通常很难预测下一次梗塞的位置。非Q波型心肌梗死通常先于Q波型心肌梗死先于Q波型心肌梗死先发更严重的狭窄，这可能提示有一定程度的心肌保护。为了证实这些发现，有必要进行前瞻性评估。
There are few data on angiographic coronary artery anatomy in patients whose coronary artery disease progresses to myocardial infarction. In this retrospective analysis, progression of coronary artery disease between two cardiac catheterization procedures is described in 38 patients: 23 patients (Group I) who had a myocardial infarction between the two studies and 15 patients (Group II) who presented with one or more new total occlusions at the second study without sustaining an intervening infarction. In Group I the median percent stenosis on the initial angiogram of the artery related to the infarct at restudy was significantly less than the median percent stenosis of lesions that subsequently were the site of a new total occlusion in group II (48 versus 73.5%, p < 0.05). In the infarct-related artery in Group I, only 5 (22%) of 23 lesions were initially > 70%, whereas in Group II, 11 (61%) of 18 lesions progressed to total occlusions were initially > 70% (p < 0.01). In Group I, patients who developed a Q wave infarction had less severe narrowing at initial angiography in the subsequent infarct-related artery (34%) than did patients who developed a non-Q wave infarction (80%) (p < 0.05). Univariate and multivariate analysis of angiographic and clinical characteristics present at initial angiography in Group I revealed proximal lesion location as the only significant predictor of evolution of lesions .gtoreq. 50% to infarction. This retrospective study suggests that myocardial infarction frequently develops from previously nonsevere lesions. In addition, it is often difficult to predict the location of a subsequent infarct from analysis of the first coronary angiogram. Non-Q wave infarction is usually preceded by a more severe pre-existing stenosis than is a Q wave infarction, perhaps indicating some degree of prior myocardial protection. A prospective evaluation will be necessary to confirm these findings.