Yip Hon-Kan, Chen Mien-Cheng, Wu Chiung-Jen, Hang Chi-Ling, Hsieh Kelvin Yuan-Kai, Fang Chih-Yuan, Yeh Kuo-Ho, Fu Morgan
Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
Cardiology. 2002;98(3):132-40. doi: 10.1159/000066322.
While coronary artery aneurysm is an uncommon anatomic disorder and has various forms, its clinical features and outcome and its impact on thrombus formation and the no-reflow phenomenon in the clinical setting of acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (p-PCI) have not been discussed. The purpose of this study was to evaluate whether this anatomic disorder predisposes to a high burden of thrombus formation, and subsequently leads to the no-reflow phenomenon and untoward clinical outcome in patients with AMI undergoing p-PCI.
In our hospital, emergency p-PCI was performed in 924 consecutive patients with AMI between May 1993 and July 2001. Of these 924 patients, 24 patients (2.6%) who had an infarct-related artery (IRA) with aneurysmal dilatation were retrospectively registered and constituted the patient population of this study. Angiographic findings demonstrated that the ectasia type (defined as diffuse dilatation of 50% or more of the length of the IRA) was found most frequently (70%), followed by the fusiform type (20%; defined as a spindle-shaped dilatation in the IRA) and the saccular type (10%; defined as a localized spherical-shaped dilatation in the IRA). The right coronary artery was the most frequently involved vessel (54.2%), followed by the left anterior descending (25.0%) and the left circumflex arteries (20.8%). Coronary angiography revealed that all of these aneurysmal IRA filled with heavy thrombus (indicated as high-burden thrombus formation). The no-reflow phenomenon (defined as <or=TIMI-2 flow) and distal embolization after p-PCI were found in 62.5 and 70.8% of the IRA, respectively. The incidence of cardiogenic shock and the 30-day mortality rate were 25 and 8.3%, respectively. The survival rate was 90.9% (20/22) during a mean follow-up of 19 +/- 30 months.
While aneurysmal dilatation of an IRA is an uncommon angiographic finding in the clinical setting of AMI, it is frequently associated with high-burden thrombus formation and has a significantly lower incidence of successful reperfusion. However, the long-term survival of these patients is excellent.
虽然冠状动脉瘤是一种罕见的解剖学疾病且有多种形式，但在接受直接经皮冠状动脉介入治疗（p-PCI）的急性心肌梗死（AMI）临床环境中，其临床特征、结局及其对血栓形成和无复流现象的影响尚未得到讨论。本研究的目的是评估这种解剖学疾病是否易导致高血栓形成负荷，并随后导致接受p-PCI的AMI患者出现无复流现象和不良临床结局。
在我院，1993年5月至2001年7月期间，对924例连续的AMI患者进行了急诊p-PCI。在这924例患者中，24例（2.6%）梗死相关动脉（IRA）有动脉瘤样扩张的患者被回顾性登记，构成了本研究的患者群体。血管造影结果显示，最常见的类型是扩张型（定义为IRA长度的50%或更多呈弥漫性扩张），占70%，其次是梭形（20%；定义为IRA呈纺锤形扩张）和囊状（10%；定义为IRA呈局限性球形扩张）。右冠状动脉是最常受累的血管（54.2%），其次是左前降支（25.0%）和左旋支动脉（20.8%）。冠状动脉造影显示，所有这些动脉瘤样IRA均充满大量血栓（提示高血栓形成负荷）。p-PCI后无复流现象（定义为TIMI-2级血流或更低）和远端栓塞分别在62.5%和70.8%的IRA中发现。心源性休克的发生率和30天死亡率分别为25%和8.3%。在平均19±30个月的随访期间，生存率为90.9%（20/22）。
虽然IRA的动脉瘤样扩张在AMI临床环境中是一种罕见的血管造影表现，但它常与高血栓形成负荷相关，且成功再灌注的发生率显著较低。然而，这些患者的长期生存率良好。
