不稳定型心绞痛的冠状动脉造影形态：隐静脉移植血管与自身冠状动脉罪犯病变的对比观察

Coronary angiographic morphology in unstable angina: comparative observations of culprit lesions in saphenous vein grafts versus native coronary arteries.

作者信息

Preston Lynn M, Calvin James E, Class Steven, Parrillo Joseph E, Klein Lloyd W

机构信息

Rush-Presbyterian-St. Luke s Medical Center, 1653 W. Congress Parkway, 1035 Jelke Pavilion, Chicago, IL 60612, USA.

出版信息

J Invasive Cardiol. 2002 Feb;14(2):81-6.

PMID:11818643

Abstract

GOAL

To compare angiographic characteristics of culprit lesions in saphenous vein grafts (SVG) with those in native coronary arteries (NCA) in patients presenting with unstable angina (UA).

METHODS

Over 4 years, a total of 445 consecutive patients undergoing coronary angiography and percutaneous coronary intervention during hospitalization for UA were identified using a prospectively collected database. Patients with enzyme or electrocardiographic (ECG) evidence for acute myocardial infarction were excluded. Single culprit lesions in SVGs were identified by angiographic and ECG criteria in 214 patients and in NCAs in 231 patients. Culprit lesions were clearly identifiable by clinical and angiographic correlation in all cases. Morphologic analysis of the culprit lesions was performed using the Ambrose classification.

RESULTS

The SVG group had male predominance (86.4% vs. 66.7%; p = 0001) and was older (67.3 +/- 9.9 years vs. 64.0 +/- 12.2 years; p = 0.0017) compared to the NCA group. Left ventricular ejection fraction was lower in the SVG group (53.8 +/- 15.5% vs. 57.5 +/- 15.2%; p = 0.063). There was a higher incidence of thrombotic-appearing lesions in SVG culprit lesions than in NCAs (31.3% vs. 6.5%; p = 0.001). There was also a higher incidence of ulcerated plaque in SVGs (36.9% vs. 22.1%; p = 0.001). Total occlusions were more common in NCAs (13.0% vs. 7.9%; p = 0.084). The composite incidence of thrombus, ulcerated plaque and total occlusion was more frequent in SVG lesions (59.4% vs. 39.8%; p = 0.001).

CONCLUSIONS

In UA, culprit lesions of SVGs assessed angiographically demonstrate morphology consistent with ulcerated plaque and thrombus more frequently than lesions in NCAs, but total occlusions are more common in NCAs. Angiographically-evident active thrombotic and ulcerated lesions underlie acute ischemic syndromes more frequently in SVGs than in native vessels.

摘要

目的

比较不稳定型心绞痛（UA）患者大隐静脉移植血管（SVG）与自身冠状动脉（NCA）中罪犯病变的血管造影特征。

方法

在4年时间里，利用前瞻性收集的数据库，共确定了445例因UA住院期间接受冠状动脉造影和经皮冠状动脉介入治疗的连续患者。排除有急性心肌梗死酶学或心电图（ECG）证据的患者。根据血管造影和ECG标准，在214例患者的SVG中以及231例患者的NCA中确定了单一罪犯病变。所有病例中通过临床和血管造影相关性均可明确识别罪犯病变。使用安布罗斯分类法对罪犯病变进行形态学分析。

结果

与NCA组相比，SVG组男性占优势（86.4%对66.7%；p = 0.0001）且年龄更大（67.3±9.9岁对64.0±12.2岁；p = 0.0017）。SVG组的左心室射血分数较低（53.8±15.5%对57.5±15.2%；p = 0.063）。SVG罪犯病变中出现血栓样病变的发生率高于NCA（31.3%对6.5%；p = 0.001）。SVG中溃疡斑块的发生率也更高（36.9%对22.1%；p = 0.001）。完全闭塞在NCA中更常见（13.0%对7.9%；p = 0.084）。血栓、溃疡斑块和完全闭塞的综合发生率在SVG病变中更频繁（59.4%对39.8%；p = 0.001）。