Xiang Ding-cheng, He Jian-xin, Hong Chang-jiang, Qiu Jian, Ma Jun, Gong Zhi-hua, Zhang Jin-xia
Department of Cardiology, Guangzhou General Hospital of Guangzhou Command, Guangzhou 510010, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Mar;34(3):227-30.
This study is aimed to compare the clinical characteristics of patients with typical and atypical coronary artery spasm.
Out of 64 patients with chest pain at rest and without significant coronary artery stenosis, coronary artery spasm was provoked by intracoronary injection of acetylcholine in 46 patients, including 12 with ST segment elevation (typical coronary artery spasm group) and 34 without ST segment elevation (atypical coronary artery spasm group). The demographic data, coronary angiographic findings, treadmill electrocardiogram, dipyridamole and rest thallium-201 myocardial perfusion computed tomography, and the follow-up clinical data of the two groups were compared.
The patients with typical coronary artery spasm were younger (47 +/- 6 vs. 58 +/- 12, P < 0.05) than patients with atypical coronary artery spasm group. Hyperlipidemia were more common in atypical coronary artery spasm group (74% vs. 33%, P < 0.05) and myocardial bridging was more common in patients with typical coronary artery spasm group (67% vs. 32%, P < 0.01). Focal coronary spasm during acetylcholine provocation was seen in 92% patients with typical coronary spasm and in 32% patients with a atypical coronary artery spasm (P < 0.01) while diffuse coronary spasm was seen in 8% patients with typical coronary spasm and in 68% patients with a atypical coronary artery spasm (P < 0.01). All patients with coronary artery spasm were treated with aspirin, calcium channel blockers, long-acting nitroglycerine, with or without lipid-lowering drugs, 2 patients with typical coronary spasm and 4 patients with atypical coronary spasm were rehospitalized due to chest pain and rest of the patients remained free of chest pain during the median follow-up period of 18 +/- 14 months.
Atypical coronary artery spasm is common in patients with rest angina and diffuse coronary microvascular spasm might be the cause of chest pain in these patients.
本研究旨在比较典型与非典型冠状动脉痉挛患者的临床特征。
在64例静息性胸痛且无明显冠状动脉狭窄的患者中，46例通过冠状动脉内注射乙酰胆碱诱发冠状动脉痉挛，其中12例出现ST段抬高（典型冠状动脉痉挛组），34例未出现ST段抬高（非典型冠状动脉痉挛组）。比较两组的人口统计学数据、冠状动脉造影结果、平板运动心电图、双嘧达莫及静息铊-201心肌灌注计算机断层扫描以及随访临床资料。
典型冠状动脉痉挛患者比非典型冠状动脉痉挛组患者更年轻（47±6岁对58±12岁，P<0.05）。高脂血症在非典型冠状动脉痉挛组更常见（74%对33%，P<0.05），心肌桥在典型冠状动脉痉挛组患者中更常见（67%对32%，P<0.01）。在典型冠状动脉痉挛患者中，92%在乙酰胆碱激发试验时出现局灶性冠状动脉痉挛，在非典型冠状动脉痉挛患者中为32%（P<0.01）；而在典型冠状动脉痉挛患者中，8%出现弥漫性冠状动脉痉挛，在非典型冠状动脉痉挛患者中为68%（P<0.01）。所有冠状动脉痉挛患者均接受阿司匹林、钙通道阻滞剂、长效硝酸甘油治疗，可加用或不加用降脂药物，在中位随访期18±14个月期间，2例典型冠状动脉痉挛患者和4例非典型冠状动脉痉挛患者因胸痛再次住院，其余患者无胸痛发作。
非典型冠状动脉痉挛在静息性心绞痛患者中常见，弥漫性冠状动脉微血管痉挛可能是这些患者胸痛的原因。
