J Cardiovasc Med (Hagerstown). 2011 Apr;12(4):297-9. doi: 10.2459/JCM.0b013e328343e962.
The aim of our study was to assess the atherosclerotic burden in patients with the first symptoms of coronary artery disease (CAD). The study population consisted of 100 consecutive patients (new-onset severe angina or myocardial infarction) and 70 age and sex matched asymptomatic volunteers. Functional and morphologic atherosclerotic markers were sought in carotid, brachial and femoral arteries of all individuals by means of high-resolution ultrasonography, whereas coronary arteriography was performed in the CAD patients only. A total of 347 coronary lesions [230 (66%) obstructive] were discovered in the CAD patients as well as 105 peripheral plaques [26 (25%) obstructive]. The mean percentage diameter stenosis of the culprit coronary lesion was 83.8 ± 15.8%, the mean vessel score 1.7 (range 0-3), the mean stenosis score 19.8 (range 1.5-89.0), and the mean extent score 49.1% (range 10-65%). Endothelium-dependent vasodilation, as assessed by the brachial flow-mediated response (FMR), was reduced by 50% in the CAD patients (P < 0.001 vs. controls). Furthermore, endothelium-independent vasodilation was significantly impaired in all investigated peripheral arteries of the CAD patients (P < 0.05-0.001 vs. controls). Intima-media thickness (IMT) was increased in the carotid arteries of the CAD patients by 43%, in brachial arteries by 20% and in femoral arteries by 57% (P < 0.01-0.001 vs. controls). Decreased FMR or increased carotid IMT was found to be independent risk factors for the CAD, and they correlated with the coronary vessel and extent scores. In conclusion, the atherosclerotic process was quite advanced in coronary as well as peripheral arteries of our patients with the first clinical presentation of CAD.
我们研究的目的是评估首次出现冠心病（CAD）症状患者的动脉粥样硬化负担。研究人群由 100 例连续患者（新发严重心绞痛或心肌梗死）和 70 名年龄和性别匹配的无症状志愿者组成。通过高分辨率超声检查，在所有个体的颈动脉、肱动脉和股动脉中寻找功能性和形态学动脉粥样硬化标志物，而仅在 CAD 患者中进行冠状动脉造影。在 CAD 患者中发现了 347 个冠状动脉病变[230 个（66%）为阻塞性病变]和 105 个外周斑块[26 个（25%）为阻塞性病变]。罪魁祸首冠状动脉病变的平均直径狭窄百分比为 83.8±15.8%，平均血管评分 1.7（范围 0-3），平均狭窄评分 19.8（范围 1.5-89.0），平均病变程度评分 49.1%（范围 10-65%）。通过肱动脉血流介导的反应（FMR）评估，CAD 患者的内皮依赖性血管舒张功能降低了 50%（P<0.001 与对照组相比）。此外，所有研究的 CAD 患者外周动脉的内皮非依赖性血管舒张功能均显著受损（P<0.05-0.001 与对照组相比）。CAD 患者的颈动脉内-中膜厚度（IMT）增加了 43%，肱动脉增加了 20%，股动脉增加了 57%（P<0.01-0.001 与对照组相比）。FMR 降低或颈动脉 IMT 增加被认为是 CAD 的独立危险因素，它们与冠状动脉血管和病变程度评分相关。总之，我们的 CAD 首发患者的冠状动脉和外周动脉的动脉粥样硬化过程已经相当严重。
