急性冠状动脉事件的既往史可预测长期稳定型心绞痛患者生物学参数及临床病程的差异。

The pre-existence of an acute coronary event predicts differences in biological parameters and clinical evolution among patients with longstanding stable angina.

作者信息

Sposito Andrei C, Lemos Pedro A, Maranhão Raul C, Mansur Antonio P, Cesar Luiz A M, Ramires Jose A F

机构信息

Heart Institute (InCor), University of São Paulo Medicine School, São Paulo, Brazil.

出版信息

Int J Cardiol. 2003 Oct;91(2-3):193-200. doi: 10.1016/s0167-5273(03)00028-7.

DOI:10.1016/s0167-5273(03)00028-7

PMID:14559130

Abstract

BACKGROUND

To date, patients displaying stable angina with or without a previous acute coronary event have been grouped together and are offered nowadays, similar clinical approach. However, from clinical experience, increasing doubt exists whether they behave clinically in the same way. In the current study, we investigated whether differences might exist in the clinical, angiographic and biological parameters between these two distinct clinical presentations.

METHODS

The cardiovascular risk factor profile, clinical evolution, angiographic data, white blood cell (WBC) count and plasma concentrations of lipids and fibrinogen were compared between two groups of patients with longstanding stable angina. The first group consisted of 160 subjects who had undergone myocardial infarction (MI) as the first manifestation of coronary artery disease (CAD) and had no further coronary event. The second group was composed of 226 subjects who had effort-induced angina but never experienced an acute coronary event. The mean period between the first CAD manifestation and entry into the study was 7+/-6 years for MI group and 7+/-4 years for patients with uneventful angina.

RESULTS

MI patients displayed 8% higher WBC count (P=0.038), 20% higher fibrinogen (P=0.001), 12% lower HDL cholesterol (P=0.02), 8% lower apoA1 (P=0.005) and 46% higher lipoprotein (a) (P=0.005) than patients who presented an uneventful clinical course. Upon multivariate logistic regression analysis, fibrinogen (OR=1.14; 95% CI=1.08-1.28; P=0.033), lipoprotein (a) (OR=1.19; 95% CI=1.05-1.34; P=0.0036) and HDL cholesterol levels (OR=0.97; 95% CI=0.94-0.99; P=0.0095) remained independently associated with the pre-existence of MI. Patients with prior MI evolved more frequently towards clinically refractory angina (P=0.04). In addition, fibrinogen levels were independently associated with evolution to clinically refractory angina (OR=1.03; 95% CI=1.005-1.550; P=0.0448).

CONCLUSIONS

Stable CAD patients with a prior MI differ from those who display an uneventful effort-induced angina in their biological profile and their evolution towards clinically refractory angina.

摘要

背景

迄今为止，患有稳定型心绞痛且有或无既往急性冠脉事件的患者被归为一组，目前采用相似的临床治疗方法。然而，根据临床经验，越来越多人怀疑他们在临床上的表现是否相同。在本研究中，我们调查了这两种不同临床表现的患者在临床、血管造影和生物学参数方面是否存在差异。

方法

比较两组长期稳定型心绞痛患者的心血管危险因素概况、临床病程、血管造影数据、白细胞（WBC）计数以及脂质和纤维蛋白原的血浆浓度。第一组由160名患者组成，他们首次出现冠状动脉疾病（CAD）的表现为心肌梗死（MI），且无进一步的冠脉事件。第二组由226名患者组成，他们有劳力性心绞痛，但从未经历过急性冠脉事件。MI组从首次出现CAD症状到进入研究的平均时间为7±6年，无事件性心绞痛患者为7±4年。

结果

与临床病程平稳的患者相比，MI患者的白细胞计数高8%（P=0.038），纤维蛋白原高20%（P=0.001），高密度脂蛋白胆固醇低12%（P=0.02），载脂蛋白A1低8%（P=0.005），脂蛋白（a）高46%（P=0.005）。多因素逻辑回归分析显示，纤维蛋白原（OR=1.14；95%CI=1.08-1.28；P=0.033）、脂蛋白（a）（OR=1.19；95%CI=1.05-1.34；P=0.0036）和高密度脂蛋白胆固醇水平（OR=0.97；95%CI=0.94-0.99；P=0.0095）仍与既往MI独立相关。既往有MI的患者更频繁地发展为临床难治性心绞痛（P=0.04）。此外，纤维蛋白原水平与发展为临床难治性心绞痛独立相关（OR=1.03；95%CI=1.005-1.550；P=0.0448）。