异常冠状动脉血管收缩作为不稳定型心绞痛患者成功冠状动脉血管成形术后再狭窄的预测指标。

Abnormal coronary vasoconstriction as a predictor of restenosis after successful coronary angioplasty in patients with unstable angina pectoris.

作者信息

Ardissino D, Barberis P, De Servi S, Merlini P A, Bramucci E, Falcone C, Specchia G

机构信息

Divisione di Cardiologia, Policlinico S. Matteo, Pavia, Italy.

出版信息

N Engl J Med. 1991 Oct 10;325(15):1053-7. doi: 10.1056/NEJM199110103251501.

DOI:10.1056/NEJM199110103251501

PMID:1891006

Abstract

BACKGROUND

High rates of restenosis after coronary angioplasty have been reported in patients with vasospastic angina. This study was designed to determine whether the occurrence of abnormal coronary vasoconstriction, detected by means of hyperventilation testing before angioplasty, influences the risk of restenosis after successful dilation.

METHODS

Hyperventilation testing was performed 0 to 4 days before coronary angioplasty in 106 consecutive patients with unstable angina and single-vessel coronary artery disease. Abnormal coronary vasoconstriction was considered present if hyperventilation-induced myocardial ischemia occurred during the recovery phase of the test. All patients had follow-up angiography 8 to 12 months after angioplasty.

RESULTS

Abnormal coronary vasoconstriction was observed in 48 patients (group 1), whereas 58 patients (group 2) had either a negative response throughout the test or a positive response only during the overbreathing phase of the hyperventilation test. Angioplasty was successful in 40 patients in group 1 and 51 in group 2. Restenosis was documented in 29 patients (73 percent) in group 1 and 13 (25 percent) in group 2 (relative risk of restenosis, 2.84; 95 percent confidence interval, 1.69 to 4.28; P less than 0.001). In a multivariate analysis, the following three characteristics were independently related to the risk of restenosis (in descending order of importance): ST-segment elevation during spontaneous ischemic attacks (P less than 0.001), hyperventilation-induced abnormal coronary vasoconstriction (P less than 0.001), and the presence of a lesion more than 10 mm long in the left anterior descending coronary artery (P less than 0.05).

CONCLUSIONS

In patients with unstable angina and single-vessel coronary artery disease who have been selected for coronary angioplasty, the presence of hyperventilation-induced abnormal coronary vasoconstriction identifies a subgroup at high risk for restenosis.

摘要

背景

有报道称，血管痉挛性心绞痛患者冠状动脉成形术后再狭窄发生率较高。本研究旨在确定血管成形术前通过过度通气试验检测到的异常冠状动脉血管收缩的发生是否会影响成功扩张后再狭窄的风险。

方法

对106例连续的不稳定型心绞痛和单支冠状动脉疾病患者在冠状动脉成形术前0至4天进行过度通气试验。如果在试验恢复阶段出现过度通气诱发的心肌缺血，则认为存在异常冠状动脉血管收缩。所有患者在血管成形术后8至12个月进行随访血管造影。

结果

48例患者（第1组）观察到异常冠状动脉血管收缩，而58例患者（第2组）在整个试验中反应阴性或仅在过度通气试验的过度呼吸阶段反应阳性。第1组40例患者和第2组51例患者血管成形术成功。第1组29例患者（73%）记录到再狭窄，第2组13例患者（25%）记录到再狭窄（再狭窄相对风险为2.84；95%置信区间为1.69至4.28；P<0.001）。在多变量分析中，以下三个特征与再狭窄风险独立相关（按重要性降序排列）：自发性缺血发作时ST段抬高（P<0.001）、过度通气诱发的异常冠状动脉血管收缩（P<0.001）以及左前降支冠状动脉存在长度超过10 mm的病变（P<0.05）。