Ellis S, Alderman E L, Cain K, Wright A, Bourassa M, Fisher L
Cardiology Division, Stanford University, California.
J Am Coll Cardiol. 1989 Jun;13(7):1481-91. doi: 10.1016/0735-1097(89)90336-7.
Despite a growing awareness of the correlation of coronary artery stenoses morphology with clinical syndromes, no comprehensive, prospective analysis of the implications of stenosis morphology on risk of myocardial infarction has been reported. Angiograms from 118 patients, representative of the 4.9% of medically treated Coronary Artery Surgery Study (CASS) patients who during subsequent 3 year follow-up study had an anterior myocardial infarction, were matched on the basis of arteriographic anatomy and disease with 141 patients who did not have an anterior infarction. Angiograms from these 259 patients with 557 left anterior descending artery stenoses were reviewed without knowledge of clinical outcome. Conditional regression analyses were performed to determine the importance of stenosis morphology, relative to computer-determined stenosis severity and other clinical variables, in the prediction of risk of infarction. Univariate analysis revealed luminal roughness (odds ratio 4.5; p = 0.001) and lesion length (odds ratio 1.7 per unit length; p = 0.007) to be highly correlated with future risk of infarction. Multivariate analysis revealed left anterior descending artery percent stenosis greater than or equal to 50%, lesion roughness, left circumflex artery stenosis and smoking, in that order, to be predictive of anterior myocardial infarction, whereas 22 other morphologic variables were not independently predictive of outcome. The importance of stenosis roughness may relate to its propensity for thrombogenesis and should be considered in clinical decision making.
尽管人们越来越意识到冠状动脉狭窄形态与临床综合征之间的相关性，但尚未有关于狭窄形态对心肌梗死风险影响的全面、前瞻性分析报告。对118例患者的血管造影进行了回顾，这些患者代表了4.9%接受药物治疗的冠状动脉外科研究（CASS）患者，在随后3年的随访研究中发生了前壁心肌梗死，根据血管造影解剖结构和疾病情况，将其与141例未发生前壁梗死的患者进行匹配。在不知道临床结果的情况下，对这259例患者的557处左前降支动脉狭窄的血管造影进行了复查。进行条件回归分析，以确定相对于计算机确定的狭窄严重程度和其他临床变量，狭窄形态在梗死风险预测中的重要性。单因素分析显示管腔粗糙度（比值比4.5；p = 0.001）和病变长度（每单位长度比值比1.7；p = 0.007）与未来梗死风险高度相关。多因素分析显示，左前降支动脉狭窄百分比大于或等于50%、病变粗糙度、左旋支动脉狭窄和吸烟依次是前壁心肌梗死的预测因素，而其他22个形态学变量不能独立预测结果。狭窄粗糙度的重要性可能与其血栓形成倾向有关，在临床决策中应予以考虑。
