Katoh Daisuke, Mizuno Yuji, Harada Eisaku, Ito Teruhiko, Morikawa Yoshinobu, Nakagawa Hitoshi, Saito Yoshihiko, Yoshimura Michihiro, Yasue Hirofumi
Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan.
Coron Artery Dis. 2012 May;23(3):141-5. doi: 10.1097/MCA.0b013e32835115ee.
Coronary spasm is implicated in the pathogenesis of acute coronary syndromes including acute myocardial infarction (AMI). Stent implantation in the primary percutaneous coronary intervention is the first choice of treatment for patients with AMI. However, the relationship between coronary spasm and stent implantation after AMI and its clinical implications remain unknown. We examined the incidence and clinical implications of provoked coronary spasm after stent implantation in patients with AMI.
Fifty-seven patients (43 men and 14 women with a mean age of 65.1±12.5 years) with ST elevation AMI who had undergone a stent implantation were the participants of this study. They underwent a provocation test for coronary spasm by intracoronary injection of acetylcholine 2-5 weeks after the attack. The patients with provoked spasms were given calcium channel blockers, and all the participants of the study were followed up for an average of 35.0±26.9 months.
Coronary spasm was induced in 40 (70.2%) and multivessel spasm in 17 (29.8%) of the 57 patients. Spasms occurred in 31 (55.4%) of the infarct-related arteries (IRAs) and 33 (30.6%) of the non-IRAs. There was no significant difference (χ=1.01, P=0.314) in the major cardiac events between the spasm group and nonspasm group during the follow-up.
Coronary spasm was provoked with a high frequency in both the IRAs and non-IRAs after stent implantation in patients with AMI. Calcium channel blockers may be useful to improve the prognosis in patients with AMI after stent implantation by suppressing coronary spasm.
冠状动脉痉挛与包括急性心肌梗死（AMI）在内的急性冠状动脉综合征的发病机制有关。在急性心肌梗死患者的直接经皮冠状动脉介入治疗中，支架植入是首选治疗方法。然而，急性心肌梗死后冠状动脉痉挛与支架植入之间的关系及其临床意义仍不清楚。我们研究了急性心肌梗死患者支架植入后诱发冠状动脉痉挛的发生率及其临床意义。
本研究纳入了57例接受支架植入的ST段抬高型急性心肌梗死患者（43例男性和14例女性，平均年龄65.1±12.5岁）。在发病后2至5周，他们通过冠状动脉内注射乙酰胆碱进行冠状动脉痉挛激发试验。对诱发痉挛的患者给予钙通道阻滞剂，并对所有研究参与者平均随访35.0±26.9个月。
57例患者中，40例（70.2%）诱发了冠状动脉痉挛，17例（29.8%）诱发了多支血管痉挛。梗死相关动脉（IRA）中有31例（55.4%）发生痉挛，非梗死相关动脉中有33例（30.6%）发生痉挛。随访期间，痉挛组和非痉挛组的主要心脏事件无显著差异（χ=1.01，P=0.314）。
急性心肌梗死患者支架植入后，梗死相关动脉和非梗死相关动脉中均频繁诱发冠状动脉痉挛。钙通道阻滞剂可能通过抑制冠状动脉痉挛，有助于改善急性心肌梗死患者支架植入后的预后。
