Clinicopathologic correlates of acute ischemic heart disease syndromes.
Clinicopathologic correlates of acute ischemic heart disease syndromes.
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急性缺血性心脏病综合征的临床病理相关性。
DOI：
10.1016/0002-9149(81)90407-0
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Willerson,JT
中科院分区：
文献类型：
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作者：
Buja,LM;Willerson,JT
为了更好地界定急性缺血性心脏病的急、慢性冠状动脉病变与不同证候的关系，本文回顾了83例100例心肌梗死患者的临床病理表现，并与前人的研究结果进行了比较。严重动脉粥样硬化（管腔截面积狭窄超过75%）累及三条或三条以上冠状动脉的占65%；两条动脉占16%，一条动脉占15%，没有动脉占4%。近期冠状动脉闭塞病变的发生率为61%，包括55例明显跨壁梗死中的50例（90.2%），26例明显心内膜下梗死中的9例（34.6%）和19例多灶性微梗死中的2例（10.5%）与急性冠状动脉功能不全的临床发作相关（p <0.001）。最近的61个闭塞性病变包括2个血栓栓塞，2个孤立的斑块出血和57个原位血栓，这些血栓与斑块侵蚀、破裂和出血的高发生率有关。26.2%的近期闭塞性梗死患者和61.5%的近期无闭塞性梗死患者在发病前就确定了易导致冠状动脉灌注减少的临床条件（p <0.001）。在63.9%的梗死患者和41.0%的梗死患者中，临床发作梗死后出现严重的心泵衰竭或充血性心力衰竭（p = 0.04）。从本研究和以往的研究可以得出：(1)急性缺血性心脏病与慢性动脉粥样硬化的严重程度没有恒定的关系；(2)心肌坏死通常发生在没有急性永久性冠状动脉闭塞的情况下，但在这种情况下，心肌坏死通常限于心内膜下不同程度的受累；(3)急性冠状动脉血栓形成经常是决定梗死范围和分布的主要因素，闭塞性冠状动脉血栓合并区域性跨壁梗死的发生率很高；(4)冠状动脉血栓的形成不依赖于冠状动脉灌注的普遍损害，无论是在梗死发生之前还是之后。
To better define the relations among acute and chronic coronary arterial lesions and different syndromes of acute ischemic heart disease, the clinicopathologic findings in 100 recent myocardial infarcts in 83 patients were reviewed and the results correlated with those of previous studies. Severe atherosclerosis (greater than 75 percent narrowing of luminal cross-sectional area) involved three or more major coronary arteries in 65 percent; two arteries in 16 percent, one artery in 15 percent, and no arteries in 4 percent of cases. The incidence rate of recent occlusive coronary arterial lesions was 61 percent, including 50 (90.2 percent) of 55 grossly apparent transmural infarcts, 9 (34.6 percent) of 26 grossly evident subendocardial infarcts and 2 (10.5 percent) of 19 multifocal microinfarcts associated with clinical episodes of acute coronary insufficiency (p <0.001). The 61 recent occlusive lesions consisted of two thromboemboli, two isolated plaque hemorrhages and 57 in situ thrombi that were associated with a high incidence rate of plaque erosion, rupture and hemorrhage. Clinical conditions predisposing to reduced coronary perfusion were identified before the onset of 26.2 percent of infarcts with recent occlusions and 61.5 percent of infarcts without recent occlusions (p <0.001). Clinical onset of infarction was followed by severe cardiac pump failure or congestive heart failure in 63.9 percent of infarcts with and 41.0 percent of infarcts without recent occlusions (p = 0.04).From this and previous studies, it is concluded that (1) acute ischemic heart disease does not have a constant relation with the severity of chronic atherosclerosis; (2) myocardial necrosis commonly occurs in the absence of acute permanent coronary occlusion, but in this setting is usually limited to subendocardial involvement of variable extent; (3) acute coronary thrombosis frequently acts as a major factor in determining the extent and distribution of an evolving infarct, as indicated by the large incidence of occlusive coronary thrombi with regional transmural infarcts; and (4) coronary thrombus formation is not dependent on a generalized impairment of coronary perfusion, either before or after the onset of infarction.