稳定型心绞痛进展为急性心肌梗死患者中梗死相关和非梗死相关狭窄的血管造影特征。

Angiographic characteristics of infarct-related and non-infarct-related stenoses in patients in whom stable angina progressed to acute myocardial infarction.

作者信息

Tousoulis D, Davies G, Crake T, Lefroy D C, Rosen S, Maseri A

机构信息

Cardiovascular Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom.

出版信息

Am Heart J. 1998 Sep;136(3):382-8. doi: 10.1016/s0002-8703(98)70210-8.

DOI:10.1016/s0002-8703(98)70210-8

PMID:9736127

Abstract

BACKGROUND

In patients with coronary artery disease, angiographic and postmortem studies have shown that coronary stenoses in infarct-related arteries often have complex morphology. It is not known whether in patients with multivessel disease stenosis morphology in non-infarct-related arteries is different from those of the infarct-related arteries.

METHODS AND RESULTS

In 24 consecutive patients we examined the angiographic characteristics of both the infarct-related stenoses and non-infarct-related stenoses before and after spontaneous acute myocardial infarction, by visual inspection and computerized edge detection of coronary angiograms. Before myocardial infarction, the severity of the infarct-related stenoses was <50% in 14 patients and > or =50% in 10 patients (p=not significant) and of non-infarct-related stenoses was <50% in 16 and > or=50% in 13. A significantly greater proportion of infarct-related stenoses with severity > or =50% progressed to non-Q-wave than to Q-wave myocardial infarction (71% vs 50%, p < 0.05). Before myocardial infarction, the percentage of concentric, eccentric, and irregular infarct-related stenoses was 8%, 13%, and 50%, respectively, whereas in the non-infarct-related stenoses it was 62%, 17%, and 21%, respectively (p < 0.01). A similar proportion of irregular morphology progressed to Q-wave or non-Q-wave myocardial infarction.

CONCLUSIONS

In patients with stable angina who had acute myocardial infarction develop, the infarct-related and non-infarct-related stenoses on average are similar in severity but different in morphology. Nonsevere stenoses more frequently progress to Q-wave than to non-Q-wave myocardial infarction.

摘要

背景

在冠状动脉疾病患者中，血管造影和尸检研究表明，梗死相关动脉中的冠状动脉狭窄通常具有复杂的形态。目前尚不清楚在多支血管病变患者中，非梗死相关动脉的狭窄形态是否与梗死相关动脉不同。

方法与结果

在24例连续患者中，我们通过冠状动脉造影的视觉检查和计算机边缘检测，检查了自发性急性心肌梗死前后梗死相关狭窄和非梗死相关狭窄的血管造影特征。心肌梗死前，14例患者梗死相关狭窄的严重程度<50%，10例患者≥50%（p无显著性差异），非梗死相关狭窄的严重程度<50%的有16例，≥50%的有13例。严重程度≥50%的梗死相关狭窄进展为非Q波心肌梗死的比例显著高于进展为Q波心肌梗死的比例（71%对50%，p<0.05）。心肌梗死前，同心、偏心和不规则梗死相关狭窄的百分比分别为8%、13%和50%，而非梗死相关狭窄分别为62%、17%和21%（p<0.01）。相似比例的不规则形态进展为Q波或非Q波心肌梗死。