Gao S Z, Alderman E L, Schroeder J S, Silverman J F, Hunt S A
Division of Cardiology, Stanford University School of Medicine, California 94305.
J Am Coll Cardiol. 1988 Aug;12(2):334-40. doi: 10.1016/0735-1097(88)90402-0.
Annual coronary arteriograms have been obtained from all heart transplant recipients at Stanford University Medical Center since 1969. Angiographic lesions in 81 transplant patients exhibiting coronary vascular disease were classified into three categories: type A, discrete or tubular stenoses; type B, diffuse concentric narrowing; and type C, narrowed irregular vessels with occluded branches. The 81 arteriograms showing transplant coronary vascular disease were contrasted with 32 from nontransplant patients with coronary artery disease analyzed in a similar fashion. The nontransplant angiograms showed 178 lesions, all of type A (discrete or tubular) morphology, 75% of which were located in primary epicardial coronary vessels and 25% in secondary branch vessels. In the patients with transplant coronary vascular disease, 349 (76%) of 461 lesions were type A: 57% in primary vessels, 42% in secondary branches and 1.4% in tertiary branches. Of the 112 type B and C lesions (diffuse narrowing, tapering and obliteration), 25% were in primary vessels, 44% in secondary vessels and 31% in tertiary branches (p less than 0.05 for patients with transplant coronary vascular disease versus patients with nontransplant coronary artery disease). Total vessel occlusion was found in proximal or middle vessel segments in 96% and distally in 4% of patients with "ordinary" coronary artery disease versus 49% distally in patients with transplant coronary disease (p less than 0.002). In the presence of total vessel occlusion, collateral vessels were poor or absent in 92% of transplant versus 7% of nontransplant patients with coronary disease (p less than 0.002). Therefore, coronary artery disease in transplant patients represents a mixture of typical atheromatous lesions and unique transplant-related progressive distal obliterative disease that occurs without collateral vessel development.
自1969年以来，斯坦福大学医学中心对所有心脏移植受者都进行了年度冠状动脉造影检查。81例患有冠状动脉疾病的移植患者的血管造影病变被分为三类：A类，离散或管状狭窄；B类，弥漫性同心狭窄；C类，血管不规则狭窄伴分支闭塞。将这81例显示移植冠状动脉疾病的血管造影与32例以类似方式分析的非移植冠状动脉疾病患者的血管造影进行对比。非移植血管造影显示178处病变，均为A类（离散或管状）形态，其中75%位于冠状动脉主要的心外膜血管，25%位于二级分支血管。在患有移植冠状动脉疾病的患者中，461处病变中的349处（76%）为A类：57%位于主要血管，42%位于二级分支，1.4%位于三级分支。在112处B类和C类病变（弥漫性狭窄、逐渐变细和闭塞）中，25%位于主要血管，44%位于二级血管，31%位于三级分支（移植冠状动脉疾病患者与非移植冠状动脉疾病患者相比，p<0.05）。“普通”冠状动脉疾病患者中，96%的患者在近端或中间血管段出现血管完全闭塞，4%在远端出现血管完全闭塞；而移植冠状动脉疾病患者中，49%在远端出现血管完全闭塞（p<0.002）。在出现血管完全闭塞的情况下，92%的移植冠状动脉疾病患者的侧支血管较差或不存在，而冠状动脉疾病非移植患者中这一比例为7%（p<0.002）。因此，移植患者的冠状动脉疾病是典型的动脉粥样硬化病变与独特的与移植相关的进行性远端闭塞性疾病的混合，且该疾病发生时无侧支血管形成。
