Im Sung Il, Rha Seung-Woon, Choi Byoung Geol, Choi Se Yeon, Kim Sun Won, Na Jin Oh, Choi Cheol Ung, Lim Hong Euy, Kim Jin Won, Kim Eung Ju, Park Chang Gyu, Seo Hong Seog, Oh Dong Joo
Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
Cardiology. 2013;125(4):250-7. doi: 10.1159/000351181. Epub 2013 Jun 29.
It is well known that myocardial bridge (MB) is a risk factor of vasospastic angina. However, clinical and angiographic characteristics according to different acetylcholine (ACh) dose in patients with MB are not clarified yet.
A total 483 consecutive patients who had angiographically proven MB underwent the intracoronary ACh provocation test. ACh was injected by incremental doses of 20, 50 and 100 μg into the left coronary artery. We evaluated the clinical and angiographic characteristics of patients with MB according to 3 different ACh doses.
The baseline clinical and procedural characteristics are well balanced among the three groups. The MB patients who responded to the lower ACh dose (20 μg) had higher incidence of baseline spasm, severe vasospasm and diffuse long spasms (>30 mm) than those who responded to the higher doses (50 and 100 μg). The incidence of 12-month mortality and recurrent chest pain was higher in the lower ACh dose group (20 μg).
The patients with MB significantly reacting at the low ACh dose had more pronounced baseline spasm, severe and diffuse long coronary artery spasm, higher 12-month mortality and recurrent chest pain than those reacting with the higher ACh doses, suggesting that more intensive medical therapy will be required.
众所周知，心肌桥（MB）是血管痉挛性心绞痛的一个危险因素。然而，MB患者中根据不同乙酰胆碱（ACh）剂量的临床和血管造影特征尚未明确。
总共483例经血管造影证实有MB的连续患者接受了冠状动脉内ACh激发试验。以递增剂量20、50和100μg将ACh注入左冠状动脉。我们根据3种不同的ACh剂量评估了MB患者的临床和血管造影特征。
三组之间的基线临床和操作特征平衡良好。对较低ACh剂量（20μg）有反应的MB患者，其基线痉挛、严重血管痉挛和弥漫性长痉挛（>30mm）的发生率高于对较高剂量（50和100μg）有反应的患者。较低ACh剂量组（20μg）的12个月死亡率和复发性胸痛发生率更高。
与对较高ACh剂量有反应的患者相比，对低ACh剂量有显著反应的MB患者有更明显的基线痉挛、严重和弥漫性长冠状动脉痉挛、更高的12个月死亡率和复发性胸痛，提示需要更强化的药物治疗。
