Asselbergs Folkert W, Piers Lieuwe H, Jessurun Gillian A J, van Boven Ad J, Veeger Nic J G M, Zijlstra Felix, van Gilst Wiek H, Tio René A
Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands.
Int J Cardiol. 2005 Aug 18;103(2):135-9. doi: 10.1016/j.ijcard.2004.08.037. Epub 2004 Dec 19.
Unknown is the predictive value of the coronary artery diameter without the administration of vasomotor stimuli. A small reference diameter of the target vessel has been demonstrated to be an adverse prognostic factor in patients undergoing revascularisation. The present study investigated the prognostic value of the proximal non-stenotic left anterior descending coronary artery (LAD) diameter in patients referred for a first diagnostic angiogram without a previous revascularisation.
A total of 277 patients (mean age 57 year, 61% male) were eligible for analysis. The proximal non-stenotic diameter of the LAD was measured by quantitative coronary angiography without prior nitrate infusion. We defined a small LAD as a diameter < or =2.5 mm. Cardiovascular events were defined as cardiac death, myocardial infarction, and hospitalizations for unstable angina.
During a median follow-up of 47 months, 24 major cardiac events occurred. The cumulative survival for patients with a small LAD was significantly lower, than for patients with a large LAD (hazard ratio 2.51; 95% confidence interval 1.11-5.66, p=0.03). In the multivariate analysis, a LAD diameter < or =2.5 mm remained a significant predictor of cardiovascular events after adjustment for age, gender, and the presence of significant coronary artery disease (hazard ratio 2.32; 95% confidence interval 1.01-5.34, p=0.048).
In patients referred for a first diagnostic angiogram without a previous revascularisation, the diameter of the proximal non-stenotic LAD is an independent predictor of cardiovascular events.
未使用血管舒缩刺激时冠状动脉直径的预测价值尚不清楚。已证明靶血管的参考直径较小是接受血运重建患者的不良预后因素。本研究调查了首次接受诊断性血管造影且既往未行血运重建的患者中，近端无狭窄的左前降支冠状动脉（LAD）直径的预后价值。
共有277例患者（平均年龄57岁，61%为男性）符合分析条件。通过定量冠状动脉造影在未预先输注硝酸盐的情况下测量LAD近端无狭窄的直径。我们将小LAD定义为直径≤2.5mm。心血管事件定义为心源性死亡、心肌梗死和因不稳定型心绞痛住院。
在中位随访47个月期间，发生了24起主要心脏事件。小LAD患者的累积生存率显著低于大LAD患者（风险比2.51；95%置信区间1.11 - 5.66，p = 0.03）。在多变量分析中，调整年龄、性别和显著冠状动脉疾病的存在后，LAD直径≤2.5mm仍然是心血管事件的显著预测因素（风险比2.32；95%置信区间1.01 - 5.34，p = 0.048）。
在首次接受诊断性血管造影且既往未行血运重建的患者中，近端无狭窄的LAD直径是心血管事件的独立预测因素。
