Ambrose J A, Hjemdahl-Monsen C E, Borrico S, Gorlin R, Fuster V
Department of Internal Medicine, Mount Sinai Medical Center, New York, New York.
Am J Cardiol. 1988 Feb 1;61(4):244-7. doi: 10.1016/0002-9149(88)90924-1.
The coronary morphology of ischemia-related arteries in unstable angina and Q-wave acute myocardial infarction (AMI) has been described. An eccentric stenosis with overhanging edges or irregular borders (type II eccentric) was seen in most lesions less than 100% occluded and probably represented plaque disruption, nonocclusive thrombus or both. The coronary morphology of non-Q AMI has not been described. Thus, the angiograms of 106 consecutive patients catheterized with either unstable angina (n = 73) or non-Q AMI (n = 33) and an identifiable ischemia-related artery were prospectively analyzed. Non-Q AMI was diagnosed by prolonged chest pain and new and persistent ST-T changes or creatine phosphokinase twice the normal level. The results showed a higher incidence of total occlusion of the ischemia-related artery in non-Q AMI (21%) compared with unstable angina (8%) (p = 0.1). The coronary morphology of nonoccluded ischemia-related arteries was similar with preponderance of type II eccentric lesions in both unstable angina and non-Q AMI. These lesions were found in 65% of ischemia-related arteries in non-Q AMI but were uncommon (3%) in nonischemia-related arteries with significant (50% to 100%) stenoses. Therefore, the type II eccentric lesion is a sensitive and specific marker of less than 100% occluded ischemia-related arteries in both unstable angina and non-Q AMI. These similarities in coronary morphology suggest a similar pathogenesis, which, as previously suggested, may relate to plaque disruption with or without thrombus. Unstable angina and non-Q AMI appear to represent part of a continuous spectrum of acute coronary artery disease. Further, the management of patients with non-Q AMI should be similar to patients with unstable angina and possibly include anticoagulation and consideration for early catheterization.
不稳定型心绞痛和Q波急性心肌梗死（AMI）中与缺血相关动脉的冠状动脉形态已被描述。在大多数小于100%闭塞的病变中可见边缘悬垂或边界不规则的偏心狭窄（II型偏心），这可能代表斑块破裂、非闭塞性血栓或两者皆有。非Q波AMI的冠状动脉形态尚未被描述。因此，对106例连续接受导管检查的患者进行了前瞻性分析，这些患者患有不稳定型心绞痛（n = 73）或非Q波AMI（n = 33），且有可识别的与缺血相关的动脉。非Q波AMI通过长时间胸痛、新出现且持续的ST-T改变或肌酸磷酸激酶水平是正常水平的两倍来诊断。结果显示，与不稳定型心绞痛（8%）相比，非Q波AMI中与缺血相关动脉完全闭塞的发生率更高（21%）（p = 0.1）。在不稳定型心绞痛和非Q波AMI中，未闭塞的与缺血相关动脉的冠状动脉形态相似，以II型偏心病变为主。在非Q波AMI中，65%的与缺血相关动脉发现了这些病变，但在狭窄程度为50%至100%的非缺血相关动脉中则不常见（3%）。因此，II型偏心病变是不稳定型心绞痛和非Q波AMI中小于100%闭塞的与缺血相关动脉的敏感且特异的标志物。冠状动脉形态的这些相似性提示了相似的发病机制，如先前所述，这可能与伴有或不伴有血栓的斑块破裂有关。不稳定型心绞痛和非Q波AMI似乎代表了急性冠状动脉疾病连续谱的一部分。此外，非Q波AMI患者的治疗应与不稳定型心绞痛患者相似，可能包括抗凝治疗以及考虑早期进行导管检查。
