摘要
目的评估心肌桥(myocardial bridge,MB)和冠状动脉痉挛(coronary artery spasm,CAS)之间的关系及其对长期预后的影响。方法连续入组812例冠状动脉无明显狭窄的MB患者接受乙酰胆碱(acetylcholine,ACH)激发试验。ACH试验将显著性冠状动脉狭窄定义为≥70%的暂时性狭窄。调整基线混杂因素后,进行Logistic回归分析。主要终点为CAS的发生率,次要终点为5年内的主要不良心脏事件(major adverse cardiac events,MACE)和需要行冠状动脉造影(coronary angiography,CAG)的复发性心绞痛。结果 ACH激发试验中,MB与CAS的高发生率、自发性痉挛、缺血性心电图改变和胸痛密切相关。不同严重程度和参考血管大小的MB与CAS的发生密切相关,重度MB是CAS的一个重要危险因素。在5年的随访中,MB伴CAS患者的心绞痛复发率高于MB不伴CAS患者。然而,MACE的发生率无统计学差异。结论重度MB与CAS发病率密切相关,MB患者复发性心绞痛的发生率较高。对于MB合并CAS的患者,需要加强药物治疗和密切的临床随访,以获得更好的临床效果。
Objective To assess the relationship between MB and CAS and its impact on long-term prognosis.Methods A total of 812 consecutive MB patients without significant stenosis in the coronary arteries underwent acetylcholine(ACH)challenge test. The ACH trial defined significant coronary stenosis as a transient stenosis of ≥70%. After adjusting for baseline confounding factors,logistic regression analysis was performed. The primary endpoint was the incidence of CAS,and the secondary endpoint was major adverse cardiac events(MACE)within 5 years and recurrent angina pectoris requiring coronary angiography(CAG).Results In the ACH challenge test,the high incidence of MB and CAS,spontaneous spasm,ischemic ECG changes,and chest pain were closely related. MB with different severity and reference vessel size is closely related to the occurrence of CAS.Severe MB is an important risk factor for CAS. During the 5-year follow-up,the recurrence rate of angina pectoris in patients with MB with CAS was higher than that in patients with MB without CAS. However,the incidence of MACE was not statistically different.Conclusion Severe MB is closely related to the incidence of CAS,and the incidence of recurrent angina pectoris is higher in MB patients. For patients who with MB and CAS,intensive drug treatment and close clinical follow-up are needed to obtain better clinical results.
作者
刘凯
陈英
夏豪
高照
吴多智
LIU Kai;CHEN Ying;XIA Hao;GAO Zhao;WU Duozhi(Elderly Medical Center of Hainan People′s Hospital,Haikou 570311,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2020年第9期1209-1213,共5页
The Journal of Practical Medicine
基金
2019年度海南省卫生计生行业科研项目(编号:19A200026)。
关键词
心肌桥
冠状动脉痉挛
乙酰胆碱
myocardial bridge
coronary spasm
acetylcholine
