PROGRESSION OF CORONARY ATHEROSCLEROSIS - IS CORONARY SPASM RELATED TO PROGRESSION
PROGRESSION OF CORONARY ATHEROSCLEROSIS - IS CORONARY SPASM RELATED TO PROGRESSION
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DOI：
10.1016/0735-1097(91)90745-u
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发表时间：
1991-10-01
影响因子：
24
通讯作者：
KIMURA, K
中科院分区：
文献类型：
--
作者：
NOBUYOSHI, M;TANAKA, M;KIMURA, K
在1974年7月至1987年6月期间，共对239例接受连续冠状动脉造影并同时进行麦角新碱激发试验的患者进行了研究。评估了冠状动脉疾病进展与危险因素的关系，特别是冠状动脉痉挛。将患者分为三组：1）新发心肌梗死组（39例患者）; 2）进展无梗死组（90例患者）;和3）非进展组为了评估风险因素和冠状动脉痉挛如何与新的心肌梗死的发生和无梗死的进展相关，检查了三组中的11个变量：年龄、性别、研究之间的时间间隔、空腹血糖、收缩压、舒张压、吸烟、血清胆固醇、甘油三酯、尿酸和麦角新碱激发试验的阳性反应。多元回归分析选择了三个独立的无梗死进展的预测因子：胆固醇（p < 0.01），收缩压（p < 0.05）和麦角新碱激发试验阳性反应（p < 0.001）。多元回归分析还选择了三个新心肌梗死发生的独立预测因素：空腹血糖（p < 0.01）、收缩压（p < 0.05）和麦角新碱激发试验阳性反应（p < 0.001）。麦角新碱激发试验的阳性反应是新发心肌梗死和无梗死进展发生的最强因素。为了评价节段性动脉变化，分析了239例患者的3,275个冠状动脉节段。新发心肌梗死和无梗死进展心肌梗死常发生在右冠状动脉近段、左前降支近段和中段以及回旋支中段。虽然在狭窄程度较重的冠状动脉段中，新发心肌梗死和无梗死进展的发生率较高，但狭窄程度<50%的冠状动脉段中新发心肌梗死的发生率> 50%，提示冠状动脉痉挛状态可能在冠状动脉疾病进展中起重要作用，常见危险因素与疾病进展密切相关。该研究还表明，心肌梗死患者经常表现出“跳跃”现象，其中最小的冠状动脉狭窄进展为完全阻塞。
A total of 239 patients undergoing serial coronary angiography with a concomitant ergonovine provocation test were studied between July 1974 and June 1987. The progression of coronary artery disease was evaluated in relation to risk factors, especially coronary artery spasm. Patients were classified into three groups: 1) new myocardial infarction group (39 patients); 2) progression without infarction group (90 patients); and 3) nonprogression group (110 patients).To assess how risk factors and coronary spasm are related to the occurrence of new myocardial infarction and progression without infarction, 11 variables in the three groups were examined: age, gender, the time interval between the studies, fasting blood sugar, systolic blood pressure, diastolic blood pressure, smoking, serum cholesterol, triglyceride, uric acid and a positive response to the ergonovine provocation test. Multiple regression analysis selected three independent predictors of progression without infarction: cholesterol (p < 0.01), systolic blood pressure (p < 0.05) and a positive response to the ergonovine provocation test (p < 0.001). Multiple regression analysis also selected three independent predictors of the occurrence of new myocardial infarction: fasting blood sugar (p < 0.01), systolic blood pressure (p < 0.05) and a positive response to the ergonovine provocation test (p < 0.001). A positive response to the ergonovine provocation test was the strongest factor for occurrence of both new myocardial infarction and progression without infarction.To evaluate segmental arterial changes, 3,275 coronary artery segments were analyzed in the 239 patients. Both new myocardial infarction and progression without infarction frequently occurred in the proximal segments of the right coronary artery, the proximal and middle segments of the left anterior descending artery and the middle segments of the circumflex coronary artery. Although occurrence of both new myocardial infarction and progression without infarction were often evident in coronary artery segments with severe narrowing, > 50% of new myocardial infarctions occurred in relation to segments narrowed < 50%.The study strongly suggests that coronary spasticity may play a significant role in progression of coronary artery disease and that usual risk factors are closely related to the disease progression. The study also demonstrates that patients with myocardial infarction often show a "jump-up" phenomenon in which a minimal coronary stenosis progresses to total obstruction.