Moise A, Théroux P, Taeymans Y, Waters D D
Am J Cardiol. 1985 Jul 1;56(1):30-4. doi: 10.1016/0002-9149(85)90561-2.
This study was performed to identify the subset of patients with normal or with minimal (49% or less) stenosis of the coronary vessels who may be prone to progressive coronary artery disease (CAD). Data were collected from 51 patients (19 men, 32 women, mean age 48 years) with normal coronary arteries (20 patients) or with minimal narrowing (31 patients) on a first angiogram, who underwent repeat catheterization 4 to 120 months later (mean 52) because of persistent chest pain. Three classic lifestyle-related risk factors (systemic hypertension, cigarette smoking status and hypercholesterolemia) were noted; the number of diseased segments on the first angiogram was counted according to a 15-segment coding system. Progression of CAD required the consensus of 3 observers on a 30% or greater decrease in luminal diameter. Progression was recorded in 16 of 31 patients with minimal CAD and in 3 of 20 patients with normal coronary arteries (p less than 0.01). By multivariate logistic regression, progression was predicted by (1) number of diseased segments (p = 0.001), (2) age (p less than 0.01), (3) smoking status (p less than 0.05) and (4) initial cholesterol level (p less than 0.05). Using the probability computed by the logistic model, we could separate the 51 patients in groups with low (0 of 18), medium (9 of 23) and high (10 of 10) risk of progression. Thus, patients with normal or minimally narrowed coronary arteries at angiography form a heterogeneous population including both normal or borderline subjects and patients with CAD at its early stage. The latter condition was associated with presence of risk factors and to the angiographic extent of the disease.
本研究旨在确定冠状动脉血管正常或狭窄程度轻微（49%或更低）但可能易患进展性冠状动脉疾病（CAD）的患者亚组。数据收集自51例患者（19例男性，32例女性，平均年龄48岁），这些患者首次血管造影显示冠状动脉正常（20例）或狭窄程度轻微（31例），由于持续胸痛，在4至120个月后（平均52个月）接受了再次导管插入术。记录了三种与生活方式相关的经典危险因素（系统性高血压、吸烟状况和高胆固醇血症）；根据15节段编码系统计算首次血管造影时病变节段的数量。CAD进展需要3名观察者一致认为管腔直径减少30%或更多。31例轻度CAD患者中有16例出现进展，20例冠状动脉正常的患者中有3例出现进展（p<0.01）。通过多变量逻辑回归分析，进展可由以下因素预测：（1）病变节段数量（p=0.001），（2）年龄（p<0.01），（3）吸烟状况（p<0.05）和（4）初始胆固醇水平（p<0.05）。使用逻辑模型计算出的概率，我们可以将51例患者分为进展风险低（18例中的0例）、中（23例中的9例）和高（10例中的10例）三组。因此，血管造影显示冠状动脉正常或轻度狭窄的患者构成了一个异质性群体，包括正常或临界受试者以及处于CAD早期阶段的患者。后一种情况与危险因素的存在以及疾病的血管造影范围有关。
