Lin Yaowang, Liu Huadong, Yu Danqing, Wu Meishan, Liu Qiyun, Liang Xinjian, Pang Xinli, Chen Keqi, Luo Linjie, Dong Shaohong
Department of Cardiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, First Affiliated Hospital of South University of Science and Technology, Shenzhen.
Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Sciences, Guangzhou, People's Republic of China.
Coron Artery Dis. 2019 Sep;30(6):418-424. doi: 10.1097/MCA.0000000000000732.
There is no clear consensus on the potential efficacy and indications for sympathectomy to prevent recurrence of vasospasm in patients with refractory coronary artery spasm (CAS).
To compare the clinical outcomes of sympathectomy with those of conventional treatment in patients with refractory CAS.
Patients with refractory CAS were randomly assigned to sympathectomy group (n = 37) or conventional treatment group (n = 42). The primary end point was a composite of major adverse cardiac event (MACE) episodes (including cardiac death, nonfatal myocardial infarction, unstable angina, heart failure, and life-threatening arrhythmia), and the secondary end point was death from any cause within 24 months after randomization.
During the follow-up period of 24 months, the incidence of MACE in the sympathectomy and conventional treatment groups was 16.22 and 61.90%, respectively (P = 0.0001). All-cause death as the secondary end point occurred in zero and six (14.29%) patients, respectively (P = 0.0272). The Kaplan-Meier curve for MACE and all-cause death showed a significant between-group difference (log-rank test, P = 0.0013 and 0.0176, respectively).
Compared with conventional treatment, sympathectomy significantly reduced the composite end point of MACE episodes and death from any cause in patients with refractory CAS by effectively preventing recurrence of vasospasm.
对于交感神经切除术预防难治性冠状动脉痉挛（CAS）患者血管痉挛复发的潜在疗效和适应证，目前尚无明确共识。
比较交感神经切除术与传统治疗方法在难治性CAS患者中的临床结局。
难治性CAS患者被随机分为交感神经切除术组（n = 37）和传统治疗组（n = 42）。主要终点是主要不良心脏事件（MACE）发作的复合终点（包括心源性死亡、非致死性心肌梗死、不稳定型心绞痛、心力衰竭和危及生命的心律失常），次要终点是随机分组后24个月内任何原因导致的死亡。
在24个月的随访期内，交感神经切除术组和传统治疗组的MACE发生率分别为16.22%和61.90%（P = 0.0001）。作为次要终点的全因死亡分别发生在0例和6例（14.29%）患者中（P = 0.0272）。MACE和全因死亡的Kaplan-Meier曲线显示组间存在显著差异（对数秩检验，P分别为0.0013和0.0176）。
与传统治疗相比，交感神经切除术通过有效预防血管痉挛复发，显著降低了难治性CAS患者MACE发作和任何原因导致的死亡这一复合终点。
