Palmeri Sebastian T, Akula Devender N, Agarwal Sanjay, Wilson Alan C, Casazza Laurie, Moreyra Abel E
Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Am J Cardiol. 2007 May 15;99(10):1374-7. doi: 10.1016/j.amjcard.2006.12.061. Epub 2007 Apr 5.
We identified 46 patients with angiographically normal coronary arteries and 16 patients with minor irregularities (luminal narrowing < or =30%) who had repeat coronary angiograms obtained at our institution during the subsequent 15-year period. On follow-up angiograms, 19 of 46 (41%) in the normal coronary group and 13 of 16 (81%) in the minor lesion group showed progression of coronary artery disease (CAD). Five patients (11%) with no angiographic luminal CAD at the time of their baseline angiogram developed an acute myocardial infarction during the follow-up period. Patients in group 1 progressed from no vessels with angiographic lesions to a mean of 0.70 +/- 0.90 vessels diseased and a mean angiographic narrowing of 24 +/- 34% at the time of their follow-up angiograms, yielding a CAD progression rate of 2.6% luminal narrowing per year. Patients in group 2 had a mean progression of 0.69 +/- 0.79% of their vessels and a mean progression in their narrowing of 34 +/- 21%, yielding a CAD progression rate of 6.0% luminal narrowing per year. In conclusion, CAD can manifest late, or more likely, many patients with apparently normal coronary arteries have intimal CAD undetectable by angiography.
我们确定了46例冠状动脉造影显示冠状动脉正常的患者以及16例有轻微不规则病变（管腔狭窄≤30%）的患者，这些患者在随后的15年期间于我们机构进行了重复冠状动脉造影。在随访造影中，正常冠状动脉组的46例中有19例（41%），轻微病变组的16例中有13例（81%）显示出冠状动脉疾病（CAD）进展。5例（11%）在基线造影时无血管造影管腔CAD的患者在随访期间发生了急性心肌梗死。第1组患者从无血管造影病变进展到随访造影时平均有0.70±0.90支血管病变，平均造影狭窄为24±34%，每年CAD进展率为管腔狭窄2.6%。第2组患者血管平均进展为0.69±0.79%，狭窄平均进展为34±21%，每年CAD进展率为管腔狭窄6.0%。总之，CAD可能在后期出现，或者更有可能的是，许多冠状动脉看似正常的患者存在血管造影无法检测到的内膜CAD。
