Bell M R, Reeder G S, Garratt K N, Berger P B, Bailey K R, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Am J Cardiol. 1993 Jun 15;71(16):1402-7. doi: 10.1016/0002-9149(93)90600-h.
Coronary dissection is a major cause of abrupt arterial closure after coronary angioplasty but may also be associated with no discernible event. Deciding which dissections should receive further treatment is often a dilemma if the artery remains patent. This case-control study examined predictors of major ischemic complications after coronary dissections. Fifty-eight patients with coronary dissections, but a patent artery at the completion of the angioplasty procedure, subsequently had in-hospital abrupt arterial closure, acute myocardial infarction, emergency coronary bypass surgery, or died; they were matched to 58 control subjects with dissection but no event. Analysis of each angiogram was performed with the examiner unaware of patient's history. Baseline angiographic and clinical characteristics of cases and controls were similar except for an excess of current smokers among the cases (31 vs 16%; p = 0.048). Residual luminal diameter at the dissection site was 1.2 +/- 0.6 mm (cases) versus 1.6 +/- 0.6 mm (controls; p = 0.001) with relative stenosis of 59 +/- 21% vs 43 +/- 21%, respectively (p = 0.0001). Dissections among cases were longer than among controls (11 +/- 7 mm vs 7 +/- 4 mm; p = 0.001). No significant difference was found in dissection morphology using 2 classification schemes or in final Thrombolysis in Myocardial Infarction study flow grade. Transient occlusion during the procedure, however, occurred in 47% of cases versus 5% of controls (p = 0.0001). Transient occlusion, residual percent stenosis > or = 70%, and dissections > or = 6 mm were independently predictive of major ischemic events.
冠状动脉夹层是冠状动脉血管成形术后动脉突然闭塞的主要原因，但也可能不伴有明显事件。如果动脉保持通畅，决定哪些夹层需要进一步治疗往往是一个难题。本病例对照研究探讨了冠状动脉夹层后主要缺血性并发症的预测因素。58例冠状动脉夹层患者在血管成形术完成时动脉通畅，但随后发生院内动脉突然闭塞、急性心肌梗死、急诊冠状动脉搭桥手术或死亡；将他们与58例有夹层但无事件的对照受试者进行匹配。在不知道患者病史的情况下，由检查者对每幅血管造影进行分析。病例组和对照组的基线血管造影和临床特征相似，只是病例组中当前吸烟者较多（31%对16%；p = 0.048）。夹层部位的残余管腔直径病例组为1.2±0.6mm，对照组为1.6±0.6mm（p = 0.001），相对狭窄率分别为59±21%和43±21%（p = 0.0001）。病例组的夹层比对照组更长（11±7mm对7±4mm；p = 0.001）。使用两种分类方案分析夹层形态或最终心肌梗死溶栓研究血流分级均未发现显著差异。然而，术中短暂闭塞在病例组中发生率为47%，在对照组中为5%（p = 0.0001）。短暂闭塞、残余狭窄百分比≥70%以及夹层≥6mm是主要缺血事件的独立预测因素。
