Salcedo A, Echevarría P, Molinero E, Sagastagoitia D, Aguirre J M, Iriarte M M, Laka Mugarza J P
Sección de Cardiología Hospital de Galdakao, Vizcaya.
Med Clin (Barc). 1996 Mar 16;106(10):372-7.
To assess the clinical evolution, in a 5-year follow-up, of the development of acute coronary syndromes, in patients with angina clinically stable, establishing its relationship with the ischemic threshold (IT) and the main modifiable cardiovascular risk factors.
120 patients, 86 males (71%), with an age of 57 +/- 8 years, with stable angina. The presence of smoking, hypercholesterolemia, hypertension and diabetes mellitus was evaluated. We performed exercise testings (baseline and after vasodilator drugs) in the beginning, in order to characterize the IT (which was fixed in 72 patients and variable in 48). The later group underwent exercise testing each term during the first year of follow-up. Lesion at least of 70% in a main coronary vessel was required as inclusion criteria. The development of acute myocardial infarction (AMI), unstable angina pectoris and cardiac death was recorded. Cox's hazard function analysis and multivariant analysis were applied.
106 patients (88%) had one or more risk factors (40% hypertension, 43% hypercholesterolemia, 22% diabetes mellitus and 56% were smokers or ex-smokers). A significant association was shown between male gender and smoking and diabetes mellitus and female gender. 6 cardiac deaths, 8 AMI and 9 unstable angina were recorded. Within the 72 patients with fixed IT, 12.5% (9) suffered some acute syndrome. In the 48 with variable IT, in the 30 who continued in it, 20% (6) developed acute coronary pathology and in the 18 who modified their IT to fixed, the prevalence was 44.5% (8). Patients with modification of IT to fixed had a higher risk of acute coronary syndrome in the follow-up (p < 0.01) and the presence of hypertension and hypercholesterolemia allowed the prediction of modification of the IT.
The prevalence of cardiovascular risk factors in the stable coronary artery disease is high (88%); male gender is associated smoking and female gender to diabetes mellitus. The presence of hypertension and hypercholesterolemia are associated to modification in the IT in patients with variable threshold, allowing the detection of a subgroup of high risk for the development of acute coronary pathology.
为评估临床稳定型心绞痛患者急性冠状动脉综合征发生情况在5年随访中的临床演变，确定其与缺血阈值（IT）及主要可改变的心血管危险因素之间的关系。
120例患者，86例男性（71%），年龄57±8岁，患有稳定型心绞痛。评估吸烟、高胆固醇血症、高血压和糖尿病的存在情况。开始时进行运动试验（基线及使用血管扩张剂药物后），以确定IT（72例患者IT固定，48例患者IT可变）。后一组在随访的第一年每个时间段都进行运动试验。纳入标准为主要冠状动脉血管至少有70%的病变。记录急性心肌梗死（AMI）、不稳定型心绞痛和心源性死亡的发生情况。应用Cox风险函数分析和多变量分析。
106例患者（88%）有一个或多个危险因素（40%为高血压，43%为高胆固醇血症，22%为糖尿病且56%为吸烟者或既往吸烟者）。男性与吸烟以及糖尿病与女性之间存在显著关联。记录到6例心源性死亡、8例AMI和9例不稳定型心绞痛。在72例IT固定的患者中，12.5%（9例）发生了某种急性综合征。在48例IT可变的患者中，30例持续可变的患者中有20%（6例）发生了急性冠状动脉病变，18例IT转变为固定的患者中，患病率为44.5%（8例）。IT转变为固定的患者在随访中发生急性冠状动脉综合征的风险更高（p<0.01），高血压和高胆固醇血症的存在可预测IT的转变。
稳定型冠状动脉疾病中心血管危险因素的患病率很高（88%）；男性与吸烟相关，女性与糖尿病相关。高血压和高胆固醇血症的存在与阈值可变患者的IT转变相关，有助于检测出急性冠状动脉病变发生风险高的亚组。
