Tikiz Hakan, Atak Ramazan, Balbay Yücel, Genç Yasemin, Kütük Emine
University of Celal Bayar, Department of Cardiology, Manisa, Turkey.
Int J Cardiol. 2002 Jan;82(1):7-14; discussion 14-6. doi: 10.1016/s0167-5273(01)00598-8.
Previous studies have reported controversial results regarding the clinical and angiographic factors involved in the left ventricular aneurysm (LVA) formation after myocardial infarction (MI).
This study was performed to determine the clinical and angiographic factors that are priori predictors of LVA following anterior myocardial infarction and so to provide a paradigm which may identify patients who were candidates for aneurysm formation.
Of the patients who underwent coronary angiography during the interval between 1995 and 2000 in our clinic, 809 were found to have anterior MI and LVA (aneurysm group) (677 men, 132 women, mean age 53.3+/-11.4 years). The clinical and the angiographic data of these patients were compared with those of 446 patients (399 men, 47 women, mean age 55.2+/-10.5 years) with previous anterior MI and without LVA (control group).
LVA was found to occur more frequently in females (16.3% in women and 10.4%, in men, P=0.03) and in patients without previous angina (23.5 vs. 8.2%, P<0.0001). Major cardiovascular risk factors, previous anti-anginal medication and thrombolytic therapy did not show a significant difference between the two groups. Angiographic examination revealed that single-vessel disease, proximal left anterior descending artery (LAD) stenosis, total LAD occlusion, mean stenosis in LAD artery, end-diastolic pressure and left ventricular score were all higher in the aneurysm group compared to control group. After adjustment for other clinical and angiographic variables, single-vessel disease [odds ratio (OR) 5.89, 95% confidence interval (CI)=3.68-9.28, P<0.0001), absence of previous angina (OR=4.21, 95% CI=2.1-7.48, P=0.0003), total LAD occlusion (OR=2.63, 95% CI=1.97-3.53, P<0.0017) and female gender (OR=1.60, 95% CI=1.20-2.28, P=0.043) remained the independent determinants of LVA formation after anterior MI.
In patients with LVA, logistic regression analysis revealed that (1) single-vessel disease, (2) absence of previous angina, (3) total LAD occlusion and (4) female gender were independent determinants in the formation of LVA after anterior MI. Coronary collateral status and risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, smoking and family history of CAD were not found to be important determinants in the aneurysm formation.
先前的研究报告了关于心肌梗死（MI）后左心室动脉瘤（LVA）形成所涉及的临床和血管造影因素的有争议结果。
进行本研究以确定前壁心肌梗死后LVA的先验预测临床和血管造影因素，从而提供一种可识别动脉瘤形成候选患者的范例。
在1995年至2000年间于我们诊所接受冠状动脉造影的患者中，发现809例患有前壁心肌梗死和LVA（动脉瘤组）（677例男性，132例女性，平均年龄53.3±11.4岁）。将这些患者的临床和血管造影数据与446例有既往前壁心肌梗死且无LVA的患者（对照组）（399例男性，47例女性，平均年龄55.2±10.5岁）的数据进行比较。
发现LVA在女性中更频繁发生（女性为16.3%，男性为10.4%，P = 0.03）以及在无既往心绞痛的患者中更频繁发生（23.5%对8.2%，P < 0.0001）。主要心血管危险因素、既往抗心绞痛药物治疗和溶栓治疗在两组之间未显示出显著差异。血管造影检查显示，与对照组相比，动脉瘤组的单支血管病变、左前降支（LAD）近端狭窄、LAD完全闭塞、LAD动脉平均狭窄、舒张末期压力和左心室评分均更高。在对其他临床和血管造影变量进行调整后，单支血管病变[比值比（OR）5.89，95%置信区间（CI）= 3.68 - 9.28，P < 0.0001]、无既往心绞痛（OR = 4.21，95% CI = 2.1 - 7.48，P = 0.0003）、LAD完全闭塞（OR = 2.63，95% CI = 1.97 - 3.53，P < 0.0017）和女性性别（OR = 1.60，95% CI = 1.20 - 2.28，P = 0.043）仍然是前壁心肌梗死后LVA形成的独立决定因素。
在LVA患者中，逻辑回归分析显示，（1）单支血管病变，（2）无既往心绞痛，（3）LAD完全闭塞和（4）女性性别是前壁心肌梗死后LVA形成的独立决定因素。未发现冠状动脉侧支循环状态和危险因素，如高血压、糖尿病、高胆固醇血症、吸烟和CAD家族史是动脉瘤形成的重要决定因素。
