[因未认识到冠状动脉痉挛而导致的潜在风险：日本冠状动脉痉挛调查问卷分析]

[Potential risk caused by the lack of recognition of coronary spasm: analysis of the coronary spasm questionnaire in Japan].

作者信息

Sueda Shozo, Oshita Akira, Izoe Yousuke, Kohno Hiroaki, Fukuda Hiroshi

机构信息

Department of Cardiology, Saiseikai Saijo Hospital, Tsuitachi 269-1, Saijo, Ehime 793-0027.

出版信息

J Cardiol. 2007 Feb;49(2):83-90.

PMID:17354582

Abstract

BACKGROUND

The spasm provocation test (SPT)is no longer widely used in patients with undiagnosed chest pain syndromes in the USA and Europe. Objectives. The clinical significance of the SPT was examined in Japan and compared with the frequency of coronary spastic angina (CSA) in institutions with and without SPT screening.

METHODS AND RESULTS

Questionnaires concerning the number of cases of coronary angiography (CAG), percutaneous coronary intervention (PCI), and invasive/non-invasive SPT in 2005 were sent to members of the Japanese Circulation Society in 1,177 cardiology hospitals. Completed surveys were returned from 208 hospitals (17.7%). Non-invasive SPT was performed in only 27 hospitals (13.0%). Invasive SPT was not performed in 50 (24.0%) institutions, and performed in the remaining 158 institutions(< 10 cases/year: 29.8%, > or = 10< 50: 33.7%, > or = 50< 100: 8.7%, > or = 100: 3.8%). There was a close correlation between the number of acetylcholine/ergonovine SPTs and the number of CSA cases finally diagnosed (acetylcholine: r(2)= 0.907, ergonovine: r(2) = 0.76). There was no difference in the number/year of CAG (525+/-451 vs 513 +/-888, NS) and PCI(175+/-156 vs 144+/-225, NS) between institutions with and without SPT screening. However, the number of CSA cases (15.6+/-21.6 vs 4.2 +/-13.0, p < 0.01) and variant angina cases (3.3+/-7.2 vs 1.4+/-2.4)in hospitals with SPT screening was higher than hospitals without SPT screening.

CONCLUSIONS

If Japanese cardiologists discontinue use of the SPT as in the USA and Europe, occurrence of CSA may disappear in the near future in Japan.

摘要

背景

在美国和欧洲，痉挛激发试验（SPT）在未确诊胸痛综合征患者中不再广泛使用。目的：在日本研究SPT的临床意义，并比较有和没有进行SPT筛查的机构中冠状动脉痉挛性心绞痛（CSA）的发生率。

方法与结果

向日本循环学会1177家心脏病医院的成员发送了关于2005年冠状动脉造影（CAG）、经皮冠状动脉介入治疗（PCI）以及侵入性/非侵入性SPT病例数的调查问卷。共收到208家医院（17.7%）的完整回复。仅27家医院（13.0%）进行了非侵入性SPT。50家机构（24.0%）未进行侵入性SPT，其余158家机构进行了侵入性SPT（每年<10例：29.8%，≥10例<50例：33.7%，≥50例<100例：8.7%，≥100例：3.8%）。乙酰胆碱/麦角新碱SPT的数量与最终确诊的CSA病例数密切相关（乙酰胆碱：r² = 0.907，麦角新碱：r² = 0.76）。进行SPT筛查和未进行SPT筛查的机构之间，每年CAG的数量（525±451对513±888，无显著差异）和PCI 的数量（175±156对144±225，无显著差异）没有差异。然而，进行SPT筛查的医院中CSA病例数（15.6±21.6对4.2±13.0，p<0.01）和变异型心绞痛病例数（3.3±7.2对1.4±2.4）高于未进行SPT筛查的医院。