Igarashi Y, Tamura Y, Tanabe Y, Fujita T, Hayashi S, Yamazoe M, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Jpn Heart J. 1994 Jul;35(4):419-30. doi: 10.1536/ihj.35.419.
The purpose of this study was to investigate the incidence of multivessel coronary spasm and compare the clinical characteristics between patients with and without multivessel coronary spasm. In variant angina, it is controversial whether coronary hyperreactivity to vasoconstrictor stimuli is localized to a segmental lesion in only one coronary artery. Moreover, the clinical characteristics of patients with multivessel coronary spasm have never been investigated. Sixty-three patients (51 men and 12 women; mean age, 56 years; range 35-72 years) with variant angina and documented ST-segment elevation during a spontaneous attack underwent spasm provocation testing with selective intracoronary injection of ergonovine. All but 4 patients who experienced spontaneous attacks during cardiac catheterization had induced coronary spasm associated with ST-segment elevation and chest pain. Multivessel coronary spasm was found in 27 (43%) of 63 patients. By univariate analysis, a high frequency of angina (> or = 3 times/week), occurrence of a spontaneous attack within 24 hours after withdrawal of medication, a long history of angina and a progressive course of angina were significantly associated with multivessel coronary spasm. Multivariate analysis indicated a positive correlation between multivessel coronary spasm and progressive angina. Multivessel coronary spasm was found in 43% of patients with variant angina. Patients with multivessel coronary spasm have some unique clinical features. These results may increase the understanding of the pathophysiology and natural course of variant angina.
本研究的目的是调查多支冠状动脉痉挛的发生率，并比较有和没有多支冠状动脉痉挛患者的临床特征。在变异型心绞痛中，冠状动脉对血管收缩刺激的高反应性是否仅局限于一条冠状动脉的节段性病变存在争议。此外，多支冠状动脉痉挛患者的临床特征从未被研究过。63例（51例男性和12例女性；平均年龄56岁；范围35 - 72岁）变异型心绞痛且在自发发作时有ST段抬高记录的患者接受了选择性冠状动脉内注射麦角新碱的痉挛激发试验。除4例在心脏导管检查期间经历自发发作的患者外，所有患者均诱发了与ST段抬高和胸痛相关的冠状动脉痉挛。63例患者中有27例（43%）发现有多支冠状动脉痉挛。单因素分析显示，心绞痛发作频繁（≥每周3次）、停药后24小时内出现自发发作、心绞痛病史长和心绞痛呈进行性病程与多支冠状动脉痉挛显著相关。多因素分析表明多支冠状动脉痉挛与进行性心绞痛之间呈正相关。43%的变异型心绞痛患者发现有多支冠状动脉痉挛。多支冠状动脉痉挛患者有一些独特的临床特征。这些结果可能会增加对变异型心绞痛病理生理学和自然病程的理解。
