Galrinho A, Ferreira R, Serra J, Rosário L, Oliveira M, Antunes E, Quininha J, Ferreira M, Antunes A M
Department of Cardiology, Santa Marta Hospital, Lisbon.
Rev Port Cardiol. 1996 Mar;15(3):217-22, 181-2.
To evaluate the influence of infarct related artery lesion morphology on the exercise stress test performed after a first myocardial infarction.
We reviewed coronary angiography and the exercise stress test performed before discharge from hospital in 105 consecutive patients (91.4% male, mean age 49.6 +/- 9.2 years) with first acute myocardial infarction. Complex coronary lesions were defined by the presence of one of the following characteristics: ulcers, thrombus, shoulders, irregularities and eccentricity. According to either the existence or absence of complex coronary lesions, two groups were considered: Group I--42 patients with complex coronary lesions, and Group II--47 patients without these characteristics in coronary angiogram. Sixteen pts (14%) were excluded because the infarct related artery was occluded or existence of complex lesions in other coronary artery not related to the infarct. Left ventricular systolic function was analyzed using the "CASS score". Exercise stress test performed between the 10th and the 15th day after myocardial infarction, using Bruce protocol, were reviewed. The following parameters were analyzed: exercise time, number of metabolic equivalent units (METS), maximal heart rate attained, double product variation and number of patients with significant ST segment depression and/or angina.
No statistically significant differences between the two groups were obtained as far as age, sex, left ventricular function, number of diseased vessels and lesions severity. From the analysis of ergometric parameters we did not find any difference between the two groups of patients about exercise time (Group A--8.37 +/- 2.6 versus (vs) Group B 8.38 +/- 3.18), METS (Group A--8.22 +/- 2.87 vs Group B--8.13 +/- 2.97), maximal heart rate (Group A--88.2% vs Group B--87.5%) and double product variation (Group A--14547 +/- 5492 vs Group B--14553 +/- 5387). However, the number of ischemic response (defined by usual criteria of St-segment depression and/or angina) was significantly greater in patients with complex coronary lesions (ST--segment depression: Group A--26 pts vs Group B--19 pts, p < 0.05/Angina: Group A--16 pts vs Group B--4 pts, p < 0.001). Thus, complex coronary lesions are related to a high incidence of residual ischemic phenomena detected by electrocardiographic exercise stress test performed on predischarge period of acute myocardial infarction. Further studies will be necessary to show the prognostic value of particular angiographic characteristics found in coronary plaques.
评估梗死相关动脉病变形态对首次心肌梗死后进行的运动负荷试验的影响。
我们回顾了105例连续的首次急性心肌梗死患者（男性占91.4%，平均年龄49.6±9.2岁）出院前的冠状动脉造影和运动负荷试验。复杂冠状动脉病变定义为具有以下特征之一：溃疡、血栓、肩部病变、不规则和偏心。根据冠状动脉造影中是否存在复杂冠状动脉病变，分为两组：第一组——42例有复杂冠状动脉病变的患者，第二组——47例冠状动脉造影中无这些特征的患者。16例患者（14%）被排除，原因是梗死相关动脉闭塞或其他与梗死无关的冠状动脉存在复杂病变。使用“CASS评分”分析左心室收缩功能。回顾了心肌梗死后第10天至第15天使用Bruce方案进行的运动负荷试验。分析了以下参数：运动时间、代谢当量单位（METS）数量、达到的最大心率、双乘积变化以及出现显著ST段压低和/或心绞痛的患者数量。
两组在年龄、性别、左心室功能、病变血管数量和病变严重程度方面无统计学显著差异。从运动参数分析来看，两组患者在运动时间（A组——8.37±2.6对B组8.38±3.18）、METS（A组——8.22±2.87对B组——8.13±2.97）、最大心率（A组——88.2%对B组——87.5%）和双乘积变化（A组——14547±5492对B组——14553±5387）方面均无差异。然而，复杂冠状动脉病变患者的缺血反应数量（根据ST段压低和/或心绞痛的常用标准定义）显著更多（ST段压低：A组——26例对B组——19例，p<0.05/心绞痛：A组——16例对B组——4例，p<0.001）。因此，复杂冠状动脉病变与急性心肌梗死出院前进行的心电图运动负荷试验检测到的残余缺血现象的高发生率相关。需要进一步研究以显示在冠状动脉斑块中发现的特定血管造影特征的预后价值。
