Chester M R, Chen L, Tousoulis D, Poloniecki J, Kaski J C
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England, United Kingdom.
J Am Coll Cardiol. 1995 Mar 15;25(4):837-42. doi: 10.1016/0735-1097(94)00472-3.
We sought to compare the evolution of complex and smooth stenoses within the same coronary tree in patients with stable coronary artery disease.
Progression of coronary stenosis has prognostic significance and may be influenced by local and systemic factors. Stenosis morphology is a determinant of disease progression, but no previous study has systematically assessed progression of complex and smooth stenoses within the same patient.
We studied 50 men with stable angina who 1) had one complex coronary stenosis and one smooth stenosis in different noninfarct-related coronary vessels at initial coronary angiography, and 2) had a second angiogram after a median interval of 9 months (range 3 to 24). Patients with lesions > or = 10 mm long, at a major branching point or with > 85% diameter reduction were not included. Coronary lesions were measured quantitatively from comparable end-diastolic frames. Stenosis morphology was determined qualitatively by two independent observers.
All patients remained in stable condition during follow-up. Progression, defined as an increase in diameter stenosis by > or = 15% was seen in only eight complex stenosis (16%) but in no smooth lesions (p < 0.01). The severity of complex stenoses changed more than that of corresponding smooth stenoses (mean +/- 1 SD 5.8 +/- 13% vs. -0.06 +/- 6%, p < 0.01). On average, the annual rate of growth was 11.4 +/- 28% and 1.5 +/- 14% for complex and smooth lesions, respectively (p < 0.01).
Few coronary stenoses progress rapidly in stable angina. Complex and smooth coronary stenoses progress at different rates within the same coronary tree. complex stenosis morphology itself is an important determinant of progression of stenosis in patients with apparently clinically stable coronary artery disease.
我们试图比较稳定型冠心病患者同一冠状动脉内复杂狭窄与光滑狭窄的演变情况。
冠状动脉狭窄的进展具有预后意义，可能受局部和全身因素影响。狭窄形态是疾病进展的一个决定因素，但此前尚无研究系统评估同一患者体内复杂狭窄与光滑狭窄的进展情况。
我们研究了50例稳定型心绞痛男性患者，这些患者1）在初次冠状动脉造影时，在不同的非梗死相关冠状动脉血管中有一处复杂冠状动脉狭窄和一处光滑狭窄，且2）在中位间隔9个月（范围3至24个月）后进行了第二次血管造影。病变长度≥10 mm、位于主要分支点或直径缩小>85%的患者未纳入。从可比的舒张末期图像定量测量冠状动脉病变。由两名独立观察者定性确定狭窄形态。
所有患者在随访期间病情保持稳定。定义为直径狭窄增加≥15%的进展情况仅在8处复杂狭窄（16%）中出现，而光滑病变中未出现（p<0.01）。复杂狭窄的严重程度变化大于相应的光滑狭窄（平均±1标准差5.8±13%对-0.06±6%，p<0.01）。平均而言，复杂病变和光滑病变的年增长率分别为11.4±28%和1.5±14%（p<0.01）。
在稳定型心绞痛中，很少有冠状动脉狭窄迅速进展。同一冠状动脉内复杂狭窄与光滑狭窄以不同速率进展。复杂狭窄形态本身是明显临床稳定型冠心病患者狭窄进展的一个重要决定因素。
