Semerdzhieva Niya E, Denchev Stefan
Emergency, National Heart Hospital, Sofia, BGR.
Cardiology, Medical Center 'Mediva', Sofia, BGR.
Cureus. 2021 Feb 4;13(2):e13130. doi: 10.7759/cureus.13130.
Оbjective Our aim was to describe the difference in epicardial coronary flow at baseline on background anti-ischaemic therapy and following intracoronary glyceryl trinitrate in patients with acute coronary syndrome and non-obstructive coronary disease with and without myocardial bridges and coronary artery fistulae. Materials and methods Coronary flow was characterized in a group of 88 patients with coronary stenoses <50% diagnosed with acute coronary syndrome using the corrected Thrombolysis in Myocardial Infarction frame count (cTFC) method at coronary angiography at baseline and after the application of 200 µg glyceryl trinitrate. Results Тhe patients with myocardial bridges and coronary artery fistulae accounted for 4.4% (n=4) and 2.2% (n=2), respectively, of the patients with acute coronary syndrome. Sixty-two (70%) of all patients demonstrated slow progression of the contrast media (cTFC>25 frames) in at least one coronary artery. Coronary flow was similarly impaired in the patients with myocardial bridges, coronary artery fistulae, and those without coronary anomalies and variants. After the intracoronary infusion of glyceryl trinitrate, the epicardial flow improved in the patients with myocardial bridges and to a lesser degree in the cases with coronary fistulae. Most of the patients who responded to glyceryl trinitrate were on background therapy with calcium channel blockers. Conclusion The epicardial coronary flow of patients with non-obstructive coronary disease with myocardial bridges and acute coronary syndrome showed less impairment compared to baseline in response to intracoronary glyceryl trinitrate applied at background anti-ischaemic therapy that included calcium channel blockers.
目的 我们的目的是描述急性冠状动脉综合征和非阻塞性冠状动脉疾病患者在接受背景抗缺血治疗时的基线心外膜冠状动脉血流情况，以及在冠状动脉内注射硝酸甘油后，有无心肌桥和冠状动脉瘘的患者的心外膜冠状动脉血流差异。材料与方法 对88例冠状动脉狭窄<50%且诊断为急性冠状动脉综合征的患者进行研究，在基线冠状动脉造影时及应用200μg硝酸甘油后，采用校正的心肌梗死溶栓帧数（cTFC）方法对冠状动脉血流进行评估。结果 心肌桥和冠状动脉瘘患者分别占急性冠状动脉综合征患者的4.4%（n = 4）和2.2%（n = 2）。所有患者中有62例（70%）在至少一支冠状动脉中显示造影剂进展缓慢（cTFC>25帧）。心肌桥患者、冠状动脉瘘患者以及无冠状动脉异常和变异的患者的冠状动脉血流同样受损。冠状动脉内注入硝酸甘油后，心肌桥患者的心外膜血流改善，冠状动脉瘘患者的改善程度较小。大多数对硝酸甘油有反应的患者正在接受钙通道阻滞剂的背景治疗。结论 在包括钙通道阻滞剂的背景抗缺血治疗下，应用冠状动脉内硝酸甘油后，患有心肌桥的非阻塞性冠状动脉疾病和急性冠状动脉综合征患者的心外膜冠状动脉血流与基线相比受损程度较小。
