Klein R M, Niehues R, Heintzen M P, Leschke M, Strauer B E
Klinik für Kardiologie, Pneumologie und Angiologie, Universität Düsseldorf.
Dtsch Med Wochenschr. 1995 Nov 3;120(44):1495-501. doi: 10.1055/s-2008-1055504.
To discover what factors indicate spontaneous coronary artery spasms as a cause of myocardial ischaemia.
In a retrospective analysis 15 of 1407 consecutive patients who had undergone coronary arteriography (six women and nine men; mean age 47 +/- 11 years) had acute ischaemia due to spontaneous coronary artery spasms. The clinical findings at the time of first investigation and during the follow-up period (mean of 29 [3-65] months) were evaluated.
The most common risk factors were hypercholesterolaemia (> or = 200 mg/dl) in ten patients (66%) and heavy nicotine consumption > or = 20 cigarettes per day) in eight patients (55%). Of the patients with angina at rest nine had reversible ST elevations, six had terminal T negativity in the ECG and an increased incidence of ventricular arrhythmias (n = 6). At time of hospitalization ten patients had acute myocardial ischaemia and five had signs of acute myocardial infarction (maximal creatine kinase concentration: 121-2980 U/l). Acute coronary angiography revealed circumscribed coronary artery constriction, reversible with nitroglycerin, with stenosis of < 70% in five patients and of > or = 70% in six, as well as intermittent vessel occlusion in four patients. Angiography showed smooth coronary artery walls in almost all instances. Angiographic evidence of circumscribed arteriosclerotic lesion with maximally 50% narrowing was present in six patients.
Especially in younger, male patients with hypercholesterolaemia and heavy smoking recurrent anginal pectoris at rest, with reversible ECG signs of myocardial ischaemia but without advanced coronary sclerosis, speaks for spontaneous coronary artery spasms as the cause.
探寻哪些因素表明自发性冠状动脉痉挛是心肌缺血的病因。
在一项回顾性分析中，1407例连续接受冠状动脉造影的患者中有15例（6名女性和9名男性；平均年龄47±11岁）因自发性冠状动脉痉挛出现急性缺血。对首次检查时及随访期间（平均29[3 - 65]个月）的临床表现进行了评估。
最常见的危险因素是10例患者（66%）存在高胆固醇血症（≥200mg/dl），8例患者（55%）重度吸烟（≥20支/天）。静息性心绞痛患者中，9例有可逆性ST段抬高，6例心电图有终末T波倒置且室性心律失常发生率增加（n = 6）。住院时，10例患者有急性心肌缺血，5例有急性心肌梗死体征（肌酸激酶最高浓度：121 - 2980U/l）。急性冠状动脉造影显示局限性冠状动脉狭窄，可被硝酸甘油逆转，5例患者狭窄<70%，6例患者狭窄≥70%，4例患者有间歇性血管闭塞。几乎所有病例的冠状动脉造影显示血管壁光滑。6例患者有局限性动脉粥样硬化病变的血管造影证据，最大狭窄50%。
特别是在年轻、患有高胆固醇血症且重度吸烟的男性患者中，反复出现静息性心绞痛，伴有心肌缺血的可逆性心电图表现但无严重冠状动脉硬化，提示自发性冠状动脉痉挛为病因。
