Eurasian Association of Therapists; Pirogov Russian national research medical university.
Eurasian Association of Therapists; Privolzhsky research medical university.
Kardiologiia. 2024 Aug 31;64(8):13-23. doi: 10.18087/cardio.2024.8.n2683.
To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.
The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).
A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.
IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.
研究纳入 KAMMA 注册研究的非阻塞性缺血性心脏病（IHD）和多灶性动脉粥样硬化（MFA）患者的临床状况和实验室及仪器检查数据。
该亚分析纳入了 1893 名接受冠状动脉造影（CAG）和外周动脉超声检查的 IHD 患者。根据 CAG 数据，患者分为两组：组 1，患者有阻塞性冠状动脉粥样硬化（CA）（最大狭窄≥50%和/或经皮冠状动脉介入治疗/冠状动脉旁路移植术史，n=1728；91.3%）和组 2，患者有非阻塞性 CA（最大狭窄<50%，n=165；8.7%）。
对纳入 KAMMA 注册研究的确诊 IHD 患者根据冠状动脉阻塞程度进行的对比分析显示，8.7%的患者有冠状动脉狭窄<50%。绝大多数非阻塞性 CA 患者的 MFA 累及头臂动脉 94.3%和下肢动脉 40.2%。非阻塞性 IHD 患者中女性居多；与阻塞性 IHD 组相比，该组吸烟和 2 型糖尿病等危险因素较少。非阻塞性 CA 患者更常伴有血脂异常病史；他们的总胆固醇和非高密度脂蛋白胆固醇水平较高；与阻塞性 CA 患者相比，他们更常接受中等强度他汀类药物治疗（55.8% vs. 34.5%）。非阻塞性 CA 患者的特征是 IHD 程度较轻，急性冠状动脉综合征病史较少。然而，组 1 和组 2 之间的卒中、外周动脉血栓形成和下肢慢性动脉功能不全的发生率没有差异，而非阻塞性 IHD 组阵发性心房颤动的发生率较高。
无冠状动脉阻塞的 IHD 患者也需要评估外周动脉状况，因为他们可能患有进展性的 MFA，在选择治疗的“攻击性”时应考虑到这一点。
