Sharma S K, Israel D H, Kamean J L, Bodian C A, Ambrose J A
Department of Medicine, Mount Sinai Medical Center, New York, NY 10029.
Am Heart J. 1993 Jul;126(1):39-47. doi: 10.1016/s0002-8703(07)80008-1.
Angiographic evidence of coronary dissection after angioplasty is found in 25% to 30% of cases. Although patients are usually asymptomatic, in a small percentage angioplasty-induced coronary dissection results in luminal impairment and ischemic complications. The present study was undertaken to identify factors responsible for a predisposition to coronary dissection after angioplasty and to determine whether major and minor dissections share the same underlying risk factors. Clinical records and angiograms from 363 patients with 489 lesions were retrospectively graded for the presence and severity of dissection and complications. Both major and minor angiographic dissections were noted in 30.3%, and in 8.8% they were major. On multivariate analysis the most significant correlates of any dissection included a balloon-to-artery ratio > 1.1 (p = 0.0001), calcification (p = 0.003), presence of other lesions in the angioplasty vessel (p = 0.018), and lesion length (p = 0.02). However, in a multivariate model there were no variables that could predict whether a dissection would be major or minor. Only the mean total number of inflations was significantly different, but this was likely the result rather than the cause of dissection. Thus a number of variables can predict the occurrence of angiographic coronary dissection after angioplasty. Major dissections constitute a small fraction of the total number but are difficult to predict differentially.
血管成形术后冠状动脉夹层的血管造影证据在25%至30%的病例中被发现。尽管患者通常无症状，但在一小部分患者中，血管成形术引起的冠状动脉夹层会导致管腔受损和缺血性并发症。本研究旨在确定血管成形术后易发生冠状动脉夹层的因素，并确定严重和轻微夹层是否具有相同的潜在危险因素。对363例患者489处病变的临床记录和血管造影进行回顾性分级，以确定夹层和并发症的存在及严重程度。严重和轻微血管造影夹层均在30.3%的病例中被发现，其中严重夹层占8.8%。多因素分析显示，任何夹层的最显著相关因素包括球囊与动脉比值>1.1（p = 0.0001）、钙化（p = 0.003）、血管成形术血管中存在其他病变（p = 0.018）和病变长度（p = 0.02）。然而，在多变量模型中，没有变量能够预测夹层是严重还是轻微。只有平均总充盈次数有显著差异，但这可能是夹层的结果而非原因。因此，许多变量可以预测血管成形术后血管造影冠状动脉夹层的发生。严重夹层占总数的一小部分，但难以进行差异预测。
