Chen L, Crook J R, Tousoulis D, Chester M R, Kaski J C
Coronary Artery Disease Research Group, Department of Cardiological Sciences, St George's Hospital Medical School, London, United Kingdom.
Am Heart J. 1998 Nov;136(5):877-83. doi: 10.1016/s0002-8703(98)70134-6.
Whether angiographic morphology of infarct-related residual stenoses continues to affect prognosis after discharge is not known.
We studied 175 patients after their myocardial infarction who required nonurgent coronary angioplasty for residual myocardial ischemia. The findings at diagnostic coronary angiography were compared with those before angioplasty (mean of 7 months later). Infarct-related stenoses were classified as complex or smooth. Stenosis progression was defined as >0.5 mm diameter reduction.
One hundred twenty-one (69%) infarct-related stenoses were complex. At restudy, total occlusion was found in 41 (35%) of the infarct-related complex stenoses compared with 7 (13%) smooth stenoses (P = .001). Reocclusion occurred in 16 (55%) of 29 complex infarct-related stenoses with thrombus, compared with 25 (28%) of 88 without thrombus (P = .01). During follow-up, 46 patients (26%) had cardiac events. Of these, 70% had complex lesions at study entry compared with 30% smooth (P < .05).
Residual angiographically complex stenoses after an uncomplicated myocardial infarction are associated with a greater risk of reocclusion and may predispose to coronary events at follow-up.
梗死相关残余狭窄的血管造影形态在出院后是否继续影响预后尚不清楚。
我们研究了175例心肌梗死后因残余心肌缺血需要进行非紧急冠状动脉血管成形术的患者。将诊断性冠状动脉造影的结果与血管成形术前（平均7个月后）的结果进行比较。梗死相关狭窄分为复杂型或平滑型。狭窄进展定义为直径减少>0.5毫米。
121例（69%）梗死相关狭窄为复杂型。复查时，梗死相关复杂狭窄中有41例（35%）出现完全闭塞，而平滑狭窄中为7例（13%）（P = .001）。29例有血栓的梗死相关复杂狭窄中有16例（55%）再次闭塞，而88例无血栓的狭窄中为25例（28%）（P = .01）。随访期间，46例患者（26%）发生心脏事件。其中，70%在研究入组时有复杂病变，而平滑病变为30%（P < .05）。
无并发症心肌梗死后残余血管造影复杂狭窄与再闭塞风险增加相关，且可能使随访时发生冠状动脉事件的风险增加。
