Freeman M R, Williams A E, Chisholm R J, Armstrong P W
Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Circulation. 1989 Jul;80(1):17-23. doi: 10.1161/01.cir.80.1.17.
In 78 consecutive patients with unstable angina, we performed coronary angiography randomized to either the first day of presentation or later during the hospital admission to assess the frequency of intracoronary thrombus and complex coronary morphology relative to the time of symptomatic presentation and the impact of these angiographic features on outcome. Early angiography (17 +/- 6 hours) was performed in 42 patients and late angiography in 36 patients (5.7 +/- 2.1 days). Twelve patients randomized to late angiography required urgent cardiac catheterization 3.9 +/- 2.2 days after admission. Coronary thrombi were present in 43% (18 of 42) of early angiography patients and in 38% (14 of 36) of late angiography patients (p = NS). Only 21% (five of 24) late elective angiography patients had coronary thrombi, but 75% (nine of 12) of late urgent angiography patients had thrombi (p less than 0.05 vs. both early and late elective angiography patients). There was no difference in the frequency of complex coronary morphology among patients randomized to early angiography (42%, or 15 of 36), late urgent angiography (42%, or five of 12), and late elective angiography (38%, or nine of 24). Cardiac events (death, myocardial infarction, and urgent revascularization) were more frequent in the patients with coronary thrombus (73%, or 23 of 32), complex coronary morphology (55%, or 16 of 29), and multiple-vessel disease (58%, or 29 of 50) than in the patients without these angiographic features (17%, or eight of 46; 31%, or 15 of 49; and 7%, or two of 28, respectively; all p less than 0.05). Multiple regression analysis demonstrated that coronary thrombus was the best angiographic predictor of cardiac events. Thus, angiographic detection of intracoronary thrombi varies according to the temporal relation between angiography and chest pain at rest.
在78例连续性不稳定型心绞痛患者中，我们对患者进行冠状动脉造影，随机安排在就诊首日或住院后期进行，以评估冠状动脉内血栓形成频率及复杂冠状动脉形态与症状发作时间的关系，以及这些血管造影特征对预后的影响。42例患者进行了早期血管造影（17±6小时），36例患者进行了晚期血管造影（5.7±2.1天）。随机安排在晚期血管造影的12例患者在入院3.9±2.2天后需要紧急心脏导管插入术。早期血管造影患者中43%（42例中的18例）存在冠状动脉血栓，晚期血管造影患者中38%（36例中的14例）存在冠状动脉血栓（p=无显著性差异）。晚期择期血管造影患者中仅21%（24例中的5例）有冠状动脉血栓，但晚期紧急血管造影患者中75%（12例中的9例）有血栓（与早期和晚期择期血管造影患者相比，p<0.05）。随机安排进行早期血管造影的患者（42%，即36例中的15例）、晚期紧急血管造影的患者（42%，即12例中的5例）和晚期择期血管造影的患者（38%，即24例中的9例）之间，复杂冠状动脉形态的频率没有差异。有冠状动脉血栓的患者（73%，即32例中的23例）、复杂冠状动脉形态的患者（55%，即29例中的16例）和多支血管病变的患者（58%，即50例中的29例）发生心脏事件（死亡、心肌梗死和紧急血运重建）的频率高于无这些血管造影特征的患者（分别为17%，即46例中的8例；31%，即49例中的15例；7%，即28例中的2例；p均<0.05）。多元回归分析表明，冠状动脉血栓是心脏事件的最佳血管造影预测指标。因此，冠状动脉内血栓的血管造影检测结果因血管造影与静息胸痛之间的时间关系而异。
