Przybojewski J Z
S Afr Med J. 1986 Dec 20;70(13):832-7.
Death directly related to selective coronary arteriography in 5 patients with a history of unstable angina pectoris during the period 1975-1985 is reported. Four different cardiologists were involved. A feature common to all the cases was the presence of significant ostial stenosis of the left mainstem coronary artery (LMCA); 2 patients had haemodynamically important obstruction of a dominant right coronary artery (RCA) ostium, while 2 others had total occlusion in the proximal part of a dominant RCA. The RCA in the last case was angiographically normal and non-dominant. Collateral coronary blood flow was fairly sparse in most cases and in 4 left ventricular dysfunction of varying degree was present. All patients developed severe hypotension and electromechanical dissociation after arteriography while still in the cardiac catheterization laboratory. Resuscitation efforts were uniformly unsuccessful. Autopsy on 1 patient demonstrated extensive obstructive coronary atherosclerosis with a massive acute anterior myocardial infarction. Cardiac catheterization poses an extremely high risk for this subgroup of patients with LMCA disease, as does selective coronary arteriography. The possible role of catheter-provoked coronary vasospasm of the LMCA is suggested; a recently introduced soft-tipped cardiovascular catheter may be more appropriate in this setting.
本文报告了1975年至1985年间5例不稳定型心绞痛患者因选择性冠状动脉造影直接导致死亡的病例。涉及4位不同的心脏病专家。所有病例的一个共同特征是左主干冠状动脉（LMCA）存在严重的开口处狭窄；2例患者右冠状动脉（RCA）优势支开口处存在血流动力学上重要的阻塞，而另外2例患者优势支RCA近端完全闭塞。最后1例患者的RCA血管造影正常且非优势支。大多数病例中冠状动脉侧支血流相当稀少，4例患者存在不同程度的左心室功能障碍。所有患者在造影后仍在心脏导管室时均出现严重低血压和心电机械分离。复苏努力均未成功。对1例患者进行尸检显示广泛的阻塞性冠状动脉粥样硬化伴大面积急性前壁心肌梗死。对于LMCA病变的这一亚组患者，心脏导管检查和选择性冠状动脉造影一样，都具有极高的风险。提示了导管诱发的LMCA冠状动脉痉挛的可能作用；在此情况下，最近推出的软头心血管导管可能更合适。
