Mori F, Uchida T, Byun T, Tanino S, Imamura K, Oomori H, Nagashima M, Enta K, Tanaka M, Kasahara S, Hirosawa K
Division of Cardiology, Sendai Cardiovascular Center.
J Cardiol. 1999 Apr;33(4):191-9.
To determine whether the site and morphology of coronary artery spasm provoked with acetylcholine can predict the long-term prognosis of vasospastic angina, coronary artery spasm (more than 90% narrowing) provoked with acetylcholine was studied in 66 consecutive patients (56 males, 10 females, mean age 56 +/- 9 years) with vasospastic angina. All patients were followed for 6.7 +/- 0.9 years and the incidence of cardiac events such as sudden death, myocardial infarction or worsened unstable angina was compared with the site and morphology of provoked spasm. The site of spasm was regarded as proximal when spasm occurred in the proximal site of 3 major coronary arteries which was designated as segment 1, 6 or 11, according to the classification of the American Heart Association, and distal in other segments. The morphology of spasm was classified into 3 types, focal (12 cases, localized more than 90% narrowing with adjoining parts constricting less than 25%), diffuse (17 cases, diffuse more than 90% narrowing), and intermediate (37 cases, localized more than 90% narrowing with adjoining parts constricting 25-90%). The site of spasm was classified into 2 types, the proximal group (24 cases) and the distal group (42 cases). Cardiac events occurred in 7 patients during the follow-up period: sudden death in 2, myocardial infarction in 2, and worsened unstable angina in 3. As to the site of spasm, the incidence of cardiac events was 21% (5/24 patients) in the proximal group, significantly higher than 5% (2/42) in the distal group (p < 0.05). As to the site of spasm, the incidence of cardiac events was 41% (5/12) in the focal group, significantly higher than 3% (1/37) in the intermediate group and 6% (1/17) in the diffuse group (p < 0.001). The presence of proximal and focal coronary artery spasm was associated with a significantly higher incidence of cardiac events. The site and morphology of coronary artery spasm provoked with acetylcholine is related to the long-term prognosis of vasospastic angina.
为了确定乙酰胆碱诱发的冠状动脉痉挛的部位和形态是否能够预测变异性心绞痛的长期预后，我们对66例连续性变异性心绞痛患者（男56例，女10例，平均年龄56±9岁）进行了研究，观察乙酰胆碱诱发的冠状动脉痉挛（狭窄超过90%）情况。所有患者均随访6.7±0.9年，比较心脏事件（如猝死、心肌梗死或恶化的不稳定型心绞痛）的发生率与诱发痉挛的部位和形态。根据美国心脏协会的分类，当痉挛发生在3支主要冠状动脉的近端部位（指定为第1、6或11节段）时，痉挛部位被视为近端，其他节段则为远端。痉挛的形态分为3种类型：局灶性（12例，局限性狭窄超过90%，相邻部位狭窄小于25%）、弥漫性（17例，弥漫性狭窄超过90%）和中间型（37例，局限性狭窄超过90%，相邻部位狭窄25%-90%）。痉挛部位分为2组：近端组（24例）和远端组（42例）。随访期间7例患者发生心脏事件：2例猝死，2例心肌梗死，3例恶化的不稳定型心绞痛。就痉挛部位而言，近端组心脏事件发生率为21%（5/24例患者），显著高于远端组的5%（2/42）（p<0.05）。就痉挛部位而言，局灶性组心脏事件发生率为41%（5/12），显著高于中间型组的3%（1/37）和弥漫性组的6%（1/17）（p<0.001）。近端和局灶性冠状动脉痉挛与心脏事件的发生率显著较高相关。乙酰胆碱诱发的冠状动脉痉挛的部位和形态与变异性心绞痛的长期预后相关。
