Hung Ming-Jui, Hung Ming-Yow, Cheng Chi-Wen, Yang Ning-I, Cherng Wen-Jin
Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
Am J Med Sci. 2007 Sep;334(3):160-7. doi: 10.1097/MAJ.0b013e3181405b30.
Limited information is available comparing the clinical characteristics and prognosis for patients with coronary vasospastic angina in the absence of hemodynamically significant coronary artery disease (CAD) (defined as >50% stenosis) versus patients with significant fixed CAD presenting with either stable angina pectoris (SAP) or acute coronary syndromes (ACS).
Patients who underwent cardiac catheterization for suspected ischemic heart disease between August 1999 and February 2003 were followed clinically. For patients without hemodynamically significant CAD, a provocation test for coronary vasospasm was undertaken using a step-wise dose of intracoronary ergonovine administration.
A total of 1134 patients were enrolled in the final analysis and stratified into 4 diagnostically distinct groups: control group (n = 239; mild CAD without coronary vasospasm); vasospasm group (n = 284; coronary vasospastic angina pectoris without hemodynamically significant CAD); SAP group (n = 110; hemodynamically significant CAD with SAP); ACS group (n = 501; hemodynamically significant CAD with ACS). Comparison of these 4 groups revealed that the ACS patients were more likely to be male, current smokers, and have hypercholesterolemia. In addition, this group had a significantly higher incidence of typical angina pectoris, 3-vessel CAD, and lower left ventricular ejection fraction. Between-group comparison revealed that vasospasm patients had a significantly higher incidence of early morning angina pectoris. Multivariate analysis showed that current smoking was the most independent risk factor associated with the diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD. During a median follow-up period of 49 months, recurrent angina pectoris was noted in patients from the control (n = 6; 3%), SAP (n = 9; 8%), vasospasm (n = 30, 11%), and ACS groups (n = 92; 18%); with nonfatal myocardial infarction identified during follow-up in the SAP (n = 5; 5%), vasospasm (n = 3; 1%), and ACS groups (n = 37; 7%). In addition, 29 and 3 cardiac deaths occurred in the ACS and SAP groups, respectively, whereas there were no such mortalities in the control and vasospasm groups.
Early morning angina pectoris and cigarette smoking were the most common clinical characteristics in patients with coronary vasospasm. These patients had an excellent prognosis despite the possibility of recurrences of vasospastic angina pectoris.
关于无血流动力学显著意义的冠状动脉疾病（CAD）（定义为狭窄>50%）的冠状动脉痉挛性心绞痛患者与表现为稳定型心绞痛（SAP）或急性冠状动脉综合征（ACS）的有显著固定性CAD患者的临床特征和预后的比较信息有限。
对1999年8月至2003年2月间因疑似缺血性心脏病接受心导管检查的患者进行临床随访。对于无血流动力学显著意义的CAD患者，采用逐步递增剂量的冠状动脉内麦角新碱给药进行冠状动脉痉挛激发试验。
共有1134例患者纳入最终分析，并分为4个诊断明确的组：对照组（n = 239；轻度CAD无冠状动脉痉挛）；痉挛组（n = 284；无血流动力学显著意义的CAD的冠状动脉痉挛性心绞痛）；SAP组（n = 110；有血流动力学显著意义的CAD伴SAP）；ACS组（n = 501；有血流动力学显著意义的CAD伴ACS）。这4组的比较显示，ACS患者更可能为男性、当前吸烟者且患有高胆固醇血症。此外，该组典型心绞痛、三支血管CAD的发生率显著更高，左心室射血分数更低。组间比较显示，痉挛患者清晨心绞痛的发生率显著更高。多变量分析显示，当前吸烟是无血流动力学显著意义的CAD患者诊断冠状动脉痉挛性心绞痛最独立的危险因素。在中位随访期49个月期间，对照组（n = 6；3%）、SAP组（n = 9；8%）、痉挛组（n = 30；11%）和ACS组（n = 92；18%）的患者出现复发性心绞痛；随访期间在SAP组（n = 5；5%）、痉挛组（n = 3；1%）和ACS组（n = 37；7%）发现非致命性心肌梗死。此外，ACS组和SAP组分别有29例和3例心源性死亡，而对照组和痉挛组无此类死亡病例。
清晨心绞痛和吸烟是冠状动脉痉挛患者最常见的临床特征。尽管可能复发痉挛性心绞痛，但这些患者预后良好。
