Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine.
Division of Cardiology, Yokohama City University Medical Center.
Circ J. 2022 Sep 22;86(10):1509-1518. doi: 10.1253/circj.CJ-22-0096. Epub 2022 May 21.
The aim of this study was to create a risk scoring model to differentiate obstructive coronary artery (CA) from CA spasm in the etioology of acute coronary syndrome (ACS).
We included 753 consecutive patients with ACS without persistent ST-segment elevation (p-STE). The exclusion criteria were: (1) out-of-hospital cardiac arrest; (2) cardiogenic shock; (3) hemodialysis; (4) atrial fibrillation/flutter; (5) severe valvular disease; (6) no coronary angiography; (7) non-obstructive coronary artery without "definite" vasospastic angina definition; and/or (8) missing data. From the multivariate logistic regression analysis for prediction of obstructive CA, an integer score of 2 to each 0.5 increment in odds ratio was given, and values were divided into quartiles according to the total score. The scores were as follows: age >70 years (6 points), non-STE myocardial infarction (9 points), diabetes mellitus (5 points), B-type natriuretic peptide >90 pg/mL (7 points), neutrophil to lymphocyte ratio >2 (5 points), and high-density lipoprotein cholesterol <50 mg/dL (5 points). CA spasm-induced ACS occurred in 50.0% in Quartile 1 (total score: 0-13), 20.5% in Quartile 2 (total score: 14-19), 4.9% in Quartile 3 (total score: 20-26), and 2.2% in Quartile 4 (total score: 27-37) (P<0.001), indicating that a total score of <20 was a potential clinical indicator of CA spasm-induced ACS.
CA spasm-induced ACS should be suspected if a total score of <20, and a spasm provocation test was being considered.
本研究旨在建立一种风险评分模型，以区分急性冠状动脉综合征（ACS）病因中的阻塞性冠状动脉（CA）与 CA 痉挛。
我们纳入了 753 例连续的非持续性 ST 段抬高型急性冠状动脉综合征（ACS）患者。排除标准为：（1）院外心脏骤停；（2）心源性休克；（3）血液透析；（4）心房颤动/扑动；（5）严重瓣膜病；（6）无冠状动脉造影；（7）非阻塞性冠状动脉且无“明确”血管痉挛性心绞痛定义；和/或（8）数据缺失。对阻塞性 CA 的多变量逻辑回归分析中，每个 0.5 倍优势比增加一个整数评分，根据总分将值分为四分位。评分如下：年龄>70 岁（6 分）、非 ST 段抬高心肌梗死（9 分）、糖尿病（5 分）、B 型利钠肽>90pg/ml（7 分）、中性粒细胞与淋巴细胞比值>2（5 分）、高密度脂蛋白胆固醇<50mg/dl（5 分）。第 1 四分位（总分为 0-13）的 CA 痉挛性 ACS 发生率为 50.0%，第 2 四分位（总分为 14-19）为 20.5%，第 3 四分位（总分为 20-26）为 4.9%，第 4 四分位（总分为 27-37）为 2.2%（P<0.001），表明总分<20 是 CA 痉挛性 ACS 的潜在临床指标。
如果总分<20，应怀疑为 CA 痉挛性 ACS，并考虑进行痉挛激发试验。
