Canavy I, Dutrillat C, Garcia E, Bonnet J L, Bory M
Service de cardiologie A, CHU Timone, Marseille.
Arch Mal Coeur Vaiss. 1999 Feb;92(2):225-33.
The aim of this study was to evaluate prospectively the respective roles of the atheromatous plaque, coronary spasm and abnormalities of haemostasis in patients with myocardial infarction with normal coronary arteries. The study population included 25 patients (19 men and 6 women) with a mean age of 52.1 +/- 11.1 years (34-76 years). The diagnosis of myocardial infarction was made as the finding of 2 out of 3 WHO criteria. It occurred spontaneously and was transmural in 80% of cases, inferior wall infarction in 9 patients (36%), anterior in 12 (48%) and lateral in 4 patients (16%). All patients underwent investigation on average 10 days after infarction (1-42 days) by coronary angiography with quantitative angiography, endocoronary ultrasonography, an ergometrine provocation test for coronary spasm and a blood coagulation study. Coronary angiography was normal in 4 patients but showed wall changes without stenosis > 50% in 20 patients and one case of aneurysmal arterial disease. Intracoronary thrombosis was detected in 6 cases. Endocoronary ultrasonography confirmed the normality of the coronary arteries in 2 cases and showed atheroma in 23 cases (soft atheroma: n = 17 and hard: n = 6). It detected 66% of the coronary thrombi observed at angiography and found 3 other cases. Coronary spasm was verified in 10 patients (40%). The coagulation study was normal in 19 patients and showed increase in Pai-1 in 5 patients and primary thrombocythemia in one case. The authors conclude that coronary angiographic data is less accurate than endo-coronary ultrasonography which best shows the extent and, above all, the nature of the plaques present in 23 of the cases (92%). Coronary spasm may be a contributing factor in 40% of cases, in situ thrombosis in 36% of cases despite usually normal blood clotting studies. None of these abnormalities was observed in one case. The embolic cause of infarction was certain in 2 cases.
本研究的目的是前瞻性评估动脉粥样硬化斑块、冠状动脉痉挛及止血异常在冠状动脉正常的心肌梗死患者中的各自作用。研究对象包括25例患者（19例男性和6例女性），平均年龄为52.1±11.1岁（34 - 76岁）。心肌梗死的诊断依据世界卫生组织三项标准中的两项。心肌梗死为自发性，80%为透壁性，9例（36%）为下壁梗死，12例（48%）为前壁梗死，4例（16%）为侧壁梗死。所有患者在心肌梗死后平均10天（1 - 42天）接受了冠状动脉造影检查，包括定量血管造影、冠状动脉内超声检查、冠状动脉痉挛的麦角新碱激发试验及凝血研究。4例患者冠状动脉造影正常，20例患者显示血管壁改变但狭窄程度<50%，1例为动脉瘤样动脉疾病。6例检测到冠状动脉内血栓形成。冠状动脉内超声检查证实2例冠状动脉正常，23例显示有动脉粥样硬化（软斑块：n = 17，硬斑块：n = 6）。它检测到血管造影中观察到的66%的冠状动脉血栓，并发现另外3例。10例患者（40%）证实有冠状动脉痉挛。19例患者凝血研究正常，5例患者纤溶酶原激活物抑制因子-1升高，1例为原发性血小板增多症。作者得出结论，冠状动脉造影数据不如冠状动脉内超声检查准确，冠状动脉内超声检查能最好地显示23例（92%）病例中斑块的范围，尤其是斑块的性质。40%的病例中冠状动脉痉挛可能是一个促成因素，36%的病例有原位血栓形成，尽管凝血研究通常正常。1例未观察到这些异常情况。2例梗死的栓子病因明确。
