Tabata H, Mizuno K, Arakawa K, Satomura K, Shibuya T, Kurita A, Nakamura H
First Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
J Am Coll Cardiol. 1995 May;25(6):1282-5. doi: 10.1016/0735-1097(95)00004-N.
The purpose of this study was to determine the prevalence of intracoronary thrombus and associated anatomic abnormalities in patients with postinfarction angina using coronary angioscopy and angiography.
Postinfarction angina, previously studied by angiographic methods only, identifies patients at high risk for sudden death, recurrent angina and refractory angina. The recent development of coronary angioscopy, which permits direct observation of a thrombus or atheroma and is especially used for the detection of intraluminal changes, encourages a reexamination of the pathogenesis of postinfarction angina.
Fifty-one consecutive patients with a diagnosis of acute myocardial infarction underwent cardiac catheterization. Coronary angiography followed immediately by coronary angioscopy was performed in 17 patients with and 34 without postinfarction angina during the same period of time (10.2 +/- 3.7 or 15.7 +/- 5.5 days [mean +/- SD]) after the onset of acute myocardial infarction.
The frequency of thrombus, as observed by angioscopy, was significantly higher in patients with than without postinfarction angina (17 of 17 vs. 5 of 34, respectively, p < 0.01). There were no significant differences between groups with respect to degree of stenosis in the infarct-related artery, number of vessels with significant stenosis, presence of collateral flow, type of therapy and risk factors.
Infarct-related artery thrombus is universally present in postinfarction angina and may be the primary pathogenic factor. Angioscopy is much more sensitive than coronary angiography for the detection of coronary thrombus.
本研究旨在利用冠状动脉血管内镜检查和血管造影术确定心肌梗死后心绞痛患者冠状动脉内血栓形成的发生率及相关解剖学异常情况。
心肌梗死后心绞痛，以往仅通过血管造影方法进行研究，可识别出猝死、复发性心绞痛和难治性心绞痛的高危患者。冠状动脉血管内镜检查的最新进展，能够直接观察血栓或动脉粥样硬化斑块，尤其用于检测管腔内变化，促使人们重新审视心肌梗死后心绞痛的发病机制。
51例诊断为急性心肌梗死的患者接受了心导管检查。在急性心肌梗死发病后的同一时间段（分别为10.2±3.7天或15.7±5.5天[平均值±标准差]），对17例有心肌梗死后心绞痛和34例无心肌梗死后心绞痛的患者立即进行了冠状动脉血管造影，随后进行冠状动脉血管内镜检查。
血管内镜检查观察到，有心肌梗死后心绞痛的患者血栓形成频率显著高于无心肌梗死后心绞痛的患者（分别为17例中的17例与34例中的5例，p<0.01）。两组在梗死相关动脉狭窄程度、存在明显狭窄的血管数量、侧支血流情况、治疗类型和危险因素方面无显著差异。
梗死相关动脉血栓在心肌梗死后心绞痛中普遍存在，可能是主要致病因素。血管内镜检查在检测冠状动脉血栓方面比冠状动脉血管造影更敏感。
