University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Bologna, Italy.
S. Orsola-Malpighi University Hospital, Cardiovascular and Thoracic Department, Bologna, Italy.
J Am Coll Cardiol. 2017 Jun 13;69(23):2808-2817. doi: 10.1016/j.jacc.2017.03.597.
Left main coronary artery (LMCA) compression is increasingly recognized as a cause of angina in pulmonary arterial hypertension (PAH).
This study aimed to evaluate the prevalence of LMCA extrinsic compression from a dilated pulmonary artery (PA) in patients with PAH and angina or angina-like symptoms, determine the usefulness of screening with computed tomography coronary angiography (CTCA), and assess the safety and efficacy of percutaneous coronary interventions (PCIs).
All patients with PAH and angina or angina-like symptoms attending the center between May 1, 2008, and December 31, 2013, underwent CTCA. Patients with confirmed LMCA stenosis on selective coronary angiography had PCI.
Of 765 patients with PAH, 121 had angina or angina-like symptoms. Ninety-four patients had abnormal CTCA based on the relationship between the PA and the LMCA and underwent selective coronary angiography. LMCA stenosis ≥50% was detected in 48 of the 94 patients. Forty-five patients underwent PCI with stenting, of whom 41 had sustained angina symptom relief. The 3 other patients had surgical PA reduction plasty. Nine months after PCI, 5 patients had LMCA restenosis and PCI was successfully repeated. The best predictor of LMCA stenosis ≥50% was a PA diameter ≥40 mm. Rates for death or double-lung transplant and the composite rates for death, double-lung transplant, or restenosis at 36 months were 5% and 30%, respectively.
The prevalence of LMCA compression in patients with PAH and angina is high. These results suggest that CTCA is indicated in patients with PAH and angina or angina-like symptoms. PCI was well tolerated, improved symptoms, and resulted in favorable long-term outcomes.
左主干冠状动脉（LMCA）受压被认为是肺动脉高压（PAH）患者心绞痛的一个原因。
本研究旨在评估肺动脉高压（PAH）伴心绞痛或类似心绞痛症状患者中，由扩张肺动脉（PA）引起的 LMCA 外压的发生率，确定计算机断层冠状动脉造影（CTCA）筛查的有效性，并评估经皮冠状动脉介入治疗（PCI）的安全性和疗效。
2008 年 5 月 1 日至 2013 年 12 月 31 日期间，所有伴有心绞痛或类似心绞痛症状的 PAH 患者均行 CTCA 检查。选择性冠状动脉造影证实 LMCA 狭窄的患者进行 PCI。
765 例 PAH 患者中，121 例有胸痛或类似胸痛症状。94 例根据 PA 与 LMCA 的关系，CTCA 结果异常，行选择性冠状动脉造影检查。48 例患者 LMCA 狭窄≥50%。45 例患者接受 PCI 支架植入术，其中 41 例患者持续胸痛症状缓解。另外 3 例患者接受了肺动脉成形术。9 个月后，5 例患者发生 LMCA 再狭窄，PCI 成功重复。LMCA 狭窄≥50%的最佳预测因素是 PA 直径≥40mm。PCI 后 36 个月时，死亡或双肺移植的发生率为 5%，死亡、双肺移植或再狭窄的复合发生率为 30%。
PAH 伴心绞痛患者 LMCA 受压的发生率较高。这些结果表明，CTCA 适用于伴有胸痛或类似胸痛症状的 PAH 患者。PCI 耐受性良好，可改善症状，并带来良好的长期预后。
