Boles Usama, Zhao Ying, Rakhit Roby, Shiu Man Fi, Papachristidis Alexandros, David Santosh, Koganti Sudheer, Gilbert Timothy, Henein Michael Y
Department of Public Health and Clinical Medicine, Umea University and Heart Centre , Umea , Sweden.
Scand Cardiovasc J. 2014 Jun;48(3):161-6. doi: 10.3109/14017431.2014.902495. Epub 2014 Apr 10.
To assess the relationship between hematological inflammatory signs, cardiovascular risk (CV) factors and prognosis in patients presenting with acute myocardial infarction (AMI) and coronary artery ectasia (CAE).
We investigated 3321 AMI patients who required urgent primary percutaneous intervention in two centres in the United Kingdom between January 2009 and August 2012. Thirty patients with CAE were compared with 60 age- and gender-matched controls. Blood was collected within 2 h of the onset of chest pain. CV risk factors were assessed from the records. Major acute cardiac events and/or mortality (MACE) over 2 years were documented.
CAE occurred in 2.7% and more often affected the right (RCA) (p = 0.001) and left circumflex artery (LCx) (0.0001). Culprit lesions were more frequently related to atherosclerosis in non-CAE patients (p = 0.001). Yet, CV risk factors failed to differentiate between the groups, except diabetes, which was less frequent in CAE (p = 0.02). CRP was higher in CAE (p = 0.006), whereas total leucocyte, neutrophil counts and neutrophil/lymphocyte ratio (N/L ratio) were lower (p = 0.002, 0.002 and 0.032, respectively) than among non-CAE. This also was the case in diffuse versus localised CAE (p = 0.02, 0.008 and 0.03, respectively). The MACE incidence did not differ between CAE and non-CAE (p = 0.083) patients, and clinical management and MACE were unrelated to the inflammatory markers.
In AMI, patients with CAE commonly have aneurysmal changes in RCA and LCx, and their inflammatory responses differ from those with non-CAE. These differences did not have prognostic relevance, and do not suggest different management.
评估急性心肌梗死（AMI）合并冠状动脉扩张（CAE）患者的血液学炎症指标、心血管风险（CV）因素与预后之间的关系。
我们调查了2009年1月至2012年8月期间在英国两个中心需要紧急进行直接经皮冠状动脉介入治疗的3321例AMI患者。将30例CAE患者与60例年龄和性别匹配的对照者进行比较。在胸痛发作后2小时内采集血液。从记录中评估CV风险因素。记录2年内的主要急性心脏事件和/或死亡率（MACE）。
CAE的发生率为2.7%，且更常累及右冠状动脉（RCA）（p = 0.001）和左旋支动脉（LCx）（p = 0.0001）。在非CAE患者中，罪犯病变与动脉粥样硬化的相关性更高（p = 0.001）。然而，除了糖尿病在CAE患者中较少见（p = 0.02）外，CV风险因素未能区分两组患者。CAE患者的CRP水平较高（p = 0.006），而白细胞总数、中性粒细胞计数和中性粒细胞/淋巴细胞比值（N/L比值）均低于非CAE患者（分别为p = 0.002、0.002和0.032）。弥漫性CAE与局限性CAE患者的情况也是如此（分别为p = 0.02、0.008和0.03）。CAE患者与非CAE患者的MACE发生率无差异（p = 0.083），并且临床管理和MACE与炎症标志物无关。
在AMI患者中，CAE患者的RCA和LCx通常存在动脉瘤样改变，其炎症反应与非CAE患者不同。这些差异与预后无关，也不提示不同的治疗方法。
