Oliva P B, Breckinridge J C
Circulation. 1977 Sep;56(3):366-74. doi: 10.1161/01.cir.56.3.366.
Coronary arteriography was performed before and after the intracoronary injection of nitroglycerin to determine the presence or absence of spasm in patients within the first 12 hours of acute myocardial infarction. Coronary arterial spasm was demonstrated in six of fifteen (40%) acute myocardial infarctions associated with coronary artery disease. In five of the six instances the interval from the onset of symptoms to arteriography was less than 6 hours. Spasm was superimposed on a high-grade atherosclerotic obstruction and was separated from the catheter tip by a segment of normal vessel in each instance. The coronary artery remained patent (following the initial relief of spasm) in two patients maintained on sublingual nitrates and heparin. Spasm, superimposed on an atherosclerotic obstruction, may be the primary event or a secondary occurrence in the pathophysiology of acute myocardial infarction. Catecholamines could play an important role in the early pathophysiology of acute myocardial infarction by producing spasm and/or platelet aggregation at the site of an atherosclerotic obstruction. A dynamic interaction between spasm, platelet aggregates and the atherosclerotic plaque may precede coronary thrombosis.
在急性心肌梗死的最初12小时内，于冠状动脉内注射硝酸甘油前后进行冠状动脉造影，以确定患者是否存在痉挛。在15例与冠状动脉疾病相关的急性心肌梗死中，有6例（40%）显示冠状动脉痉挛。在这6例中的5例中，从症状发作到血管造影的间隔时间少于6小时。痉挛叠加在高度动脉粥样硬化性阻塞之上，且在每例中均与导管尖端之间隔一段正常血管。在两名持续使用舌下硝酸酯类药物和肝素的患者中，冠状动脉在（痉挛最初缓解后）仍保持通畅。叠加在动脉粥样硬化性阻塞之上的痉挛，可能是急性心肌梗死病理生理学中的主要事件或次要事件。儿茶酚胺可能通过在动脉粥样硬化性阻塞部位产生痉挛和/或血小板聚集，在急性心肌梗死的早期病理生理学中发挥重要作用。痉挛、血小板聚集体与动脉粥样硬化斑块之间的动态相互作用可能先于冠状动脉血栓形成。
