PROGNOSTIC IMPLICATIONS OF ANGIOGRAPHICALLY NORMAL AND INSIGNIFICANTLY NARROWED CORONARY-ARTERIES
PROGNOSTIC IMPLICATIONS OF ANGIOGRAPHICALLY NORMAL AND INSIGNIFICANTLY NARROWED CORONARY-ARTERIES
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DOI：
10.1016/0002-9149(86)90378-4
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发表时间：
1986-12-01
影响因子：
2.8
通讯作者：
PRYOR, DB
中科院分区：
文献类型：
--
作者：
PAPANICOLAOU, MN;CALIFF, RM;PRYOR, DB
研究了1,977例冠状动脉正常或“无意义”冠状动脉疾病（CAD）（无主要心外膜动脉，管腔直径狭窄75%或以上）的连续患者的临床表现和预后。与严重CAD患者相比，这些患者的传统心脏危险因素和静息和运动心电图异常频率较低。对于冠状动脉正常或不明显狭窄的患者，5年随访时心脏存活率为99%，10年为98%。冠状动脉正常的患者与无显著CAD的患者在无心肌梗死生存率方面存在差异：冠状动脉正常的患者5年无心肌梗死生存率为99%，10年无心肌梗死生存率为98%，而无显著CAD的患者5年无心肌梗死生存率为97%，10年无心肌梗死生存率为90%。在不显著的CAD的量和后续心脏事件之间出现强相关（χ 2 = 21.5，p < 0.0001）。当单独考虑时，心脏风险因素与随访心血管事件的风险在统计学上相关（χ 2 = 4.93，p = 0.026），但在调整冠状动脉解剖结构的影响后，这种关系失去了意义。两组患者继续有心脏症状，导致频繁住院，药物使用和工作残疾。在任何一年的随访中，几乎有50%的患者不能进行高代谢当量要求的活动，70%的患者有持续的胸部不适症状。虽然这些患者死亡风险较低，但许多患者多年来仍存在功能障碍。
The clinical presentation and prognosis of 1,977 consecutive patients with normal coronary arteries or "insignificant" coronary artery disease (CAD) (no major epicardial artery with 75% or more luminal diametr narrowing) were examined. Compared with patients with significant CAD, these patients had a lower frequency of traditional cardiac risk factors and abnormalities on the rest and exercise electrocardiogram. Cardiac survival was 99% at 5 years of follow-up and 98% at 10 years for patients with normal or insignificantly narrowed coronary arteries. Patients with normal coronary arteries differed from those with insignificant CAD in their myocardial infarction free survival rate: 99% at 5 years and 98% at 10 years for patients with normal coronary arteries, compared with 97% at 5 years and 90% at 10 years for patients with insignificant CAD. A strong relation occurred between the amount of insignificant CAD and follow-up cardiac events (.chi.2 = 21.5, p < 0.0001). Cardiac risk factors were statistically related to the risk of follow-up cardiovascular events when considered alone (.chi.2 = 4.93, p = 0.026), but this relation lost significance after adjusting for the effect of coronary anatomy. Patients in both groups continued to have cardiac symptoms that resulted in frequent hospitalizations, medication use and job disability. Almost 50% in any given year of follow-up could not perform activities of high metabolic equivalent requirement and 70% had continuing symptoms of chest discomfort. Although these patients are at low risk of death, many remain functionally impaired for years.