Nishimura S, Nakanishi S, Nishiyama S, Kato K, Kondo K, Imai S, Nishikawa H, Seki A, Yamaguchi H
Cardiovascular Center, Toranomon Hospital, Tokyo.
J Cardiol. 1988 Mar;18(1):1-11.
The correlation between progression of atherosclerotic lesions and the compensatory development of collaterals which prevent ischemic events, particularly myocardial infarction, were examined in patients who underwent repeated coronary angiography (CAG) after medical therapy. Twenty-five patients with lesions in their coronary arteries perfusing the viable myocardium during the first study, which progressed to total occlusion in the second study, were evaluated. The subjects' mean age was 55.1 years, and the mean time interval between the two studies was 44.1 months. CAG was performed in the chronic stage of myocardial infarction or the stable phase of angina pectoris, but three patients underwent repeated CAG studies during the acute phase of myocardial infarction. The percent diameter of the narrowing in the lesion was assessed according to the AHA system. Concerning the sites of lesions with progression to complete occlusion, 14 (56%) were located in the proximal segment of the left anterior descending artery (segment 6 or 7), and six lesions were in the main trunk of the right coronary artery (segment 1, 2 or 3). In 11 patients with stable angina, associated lesions showed progression from 90 or 99% stenosis to complete occlusion. Seven patients with lesions exhibiting 99% stenosis had collaterals, and four patients with lesions exhibiting 90% stenosis had no collaterals during the first study. However, good collaterals were demonstrated in all patients in the second study. Seven patients had episodes of newly developed unstable angina. The lesions in five of the seven patients progressed from 75% or 90% stenosis to complete occlusion, and in one patient with triple vessel disease the lesion progressed from 99% stenosis to complete occlusion in the second study. The former five patients did not have collaterals in the first study, but development of collaterals was demonstrated in all seven patients in the second study. Seven patients had episodes of myocardial infarction, and in six of these, the lesions progressed from 75% or less stenosis to complete occlusion.(ABSTRACT TRUNCATED AT 400 WORDS)
在接受药物治疗后接受重复冠状动脉造影（CAG）的患者中，研究了动脉粥样硬化病变进展与预防缺血事件（尤其是心肌梗死）的侧支循环代偿性发育之间的相关性。对25例患者进行了评估，这些患者在首次研究时冠状动脉中有灌注存活心肌的病变，在第二次研究时进展为完全闭塞。受试者的平均年龄为55.1岁，两次研究之间的平均时间间隔为44.1个月。CAG在心肌梗死的慢性期或心绞痛的稳定期进行，但有3例患者在心肌梗死急性期接受了重复CAG研究。根据美国心脏协会（AHA）系统评估病变处狭窄的直径百分比。关于进展为完全闭塞的病变部位，14处（56%）位于左前降支近端节段（6或7段），6处病变位于右冠状动脉主干（1、2或3段）。在11例稳定型心绞痛患者中，相关病变从90%或99%狭窄进展为完全闭塞。在首次研究中，7例病变显示99%狭窄的患者有侧支循环，4例病变显示90%狭窄的患者没有侧支循环。然而，在第二次研究中所有患者均显示有良好的侧支循环。7例患者出现新发不稳定型心绞痛。7例患者中有5例的病变从75%或90%狭窄进展为完全闭塞，在1例三支血管病变患者中，病变在第二次研究中从99%狭窄进展为完全闭塞。前5例患者在首次研究中没有侧支循环，但在第二次研究中所有7例患者均显示有侧支循环发育。7例患者发生心肌梗死，其中6例的病变从75%或更低狭窄进展为完全闭塞。（摘要截选至400字）
