Bergelson B A, Ruocco N A, Ryan T J, Hankin B R, Jacobs A K, Faxon D P
Evans Memorial Department of Clinical Research, Boston University Medical Center, Massachusetts.
J Am Coll Cardiol. 1989 Jul;14(1):91-5. doi: 10.1016/0735-1097(89)90057-0.
Patients with a significant residual stenosis after thrombolytic therapy are believed by many to be at increased risk for repeat ischemic events and may be candidates for prompt angiography and revascularization. To test the hypothesis that patients with antecedent angina (Canadian classes I to IV, greater than or equal to 24 h before myocardial infarction) are more likely to have a significant residual stenosis (greater than or equal to 60% diameter reduction) than are those without antecedent angina, the coronary angiograms of 82 consecutive patients undergoing routine angiography after thrombolytic therapy were reviewed. Compared with the patients without antecedent angina, the group with antecedent angina had an increased mean stenosis (74% versus 58%) and more multivessel disease (44% versus 5%). The sensitivity and specificity of a clinical history of antecedent angina predicting the presence of a significant residual stenosis were 75% and 96%, respectively; the positive predictive accuracy was 98%. These data suggest that antecedent angina can be used to identify a high risk subgroup whose condition may warrant routine coronary angiography.
许多人认为，溶栓治疗后存在明显残余狭窄的患者再次发生缺血事件的风险增加，可能需要及时进行血管造影和血运重建。为了验证先前有过心绞痛（加拿大心血管学会分级I至IV级，心肌梗死前24小时或更长时间）的患者比没有先前心绞痛的患者更有可能存在明显残余狭窄（直径缩小≥60%）这一假设，我们回顾了82例溶栓治疗后接受常规血管造影的连续患者的冠状动脉造影结果。与没有先前心绞痛的患者相比，有先前心绞痛的患者平均狭窄程度更高（74%对58%），多支血管病变更多（44%对5%）。先前心绞痛的临床病史预测存在明显残余狭窄的敏感性和特异性分别为75%和96%；阳性预测准确率为98%。这些数据表明，先前心绞痛可用于识别一个高危亚组，其病情可能需要进行常规冠状动脉造影。
