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投稿时间：2023-11-22 网络发布日期：2024-08-20
投稿时间：2023-11-22 网络发布日期：2024-08-20
中文摘要: 目的 探讨冠状动脉（冠脉）痉挛合并阻塞性狭窄患者的临床特点及支架植入对其预后的影响。方法 采用回顾性观察性研究方法，选取南京江北医院2009年6月至2021年6月入院诊断冠脉痉挛综合征(CASS）的患者44例,根据冠脉造影(CAG）检查结果中，痉挛冠脉是否存在直径≥50%的狭窄,分为冠脉痉挛合并阻塞性狭窄组（n=24）和冠脉痉挛无阻塞性狭窄组（n=20），观察药物治疗或联合支架植入的疗效, 随访观察主要不良心血管事件(MACE）或死亡情况。结果 冠脉痉挛合并阻塞性狭窄组与不合并阻塞性狭窄组性别、年龄、危险因素（高血压、糖尿病、酗酒、吸烟）、实验室检查指标［血糖（Glu）、低密度脂蛋白胆固醇(LDL-C)、总胆固醇］、心肌损伤标志物 ［心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶CK-MB)］峰值、射血分数（EF）、心电图下壁ST段抬高比例差异均无统计学意义（P＞0.05）。冠脉痉挛合并阻塞性狭窄24例中,5例（20.83%）药物治疗，19例（79.17%）行PCI ［其中15例（78.95%）在痉挛伴狭窄冠脉实施，4例（21.05%）在非痉挛冠脉实施］。痉挛冠脉无狭窄20例中，16例右冠脉（RCA）痉挛（其中13例RCA完全正常伴痉挛，3例伴20%～30%狭窄），4例左前降支（LAD）痉挛（2例完全正常，2例伴30%～40%狭窄），仅1例（5.00%）在非痉挛冠脉行PCI。冠脉痉挛合并阻塞性狭窄组随访24~129（64.13±29.80）个月，心绞痛复发4例，支架内狭窄1例，1例支架极晚期血栓导致急性心肌梗死行紧急PCI。冠脉痉挛无狭窄组随访30~168（64.75±32.54）个月，心绞痛复发7例，死亡1例，两组MACE的发生率（25.00% vs 40.00%）差异无统计学意义（P＞0.05）。结论 冠脉痉挛合并阻塞性狭窄患者可选择药物联合支架植入治疗,能取得良好预后,但应在腔内影像指导下实施。
Abstract:Objective To investigate the clinical characteristics of patients with coronary artery spasm (CAS) combined with obstructive stenosis and the impact of stent implantation on their prognosis. Methods A retrospective observational study was conducted on patients admitted to Nanjing Jiangbei Hospital from June 2009 to June 2021, diagnosed with coronary artery spasm syndrome (CASS). Based on the results of coronary angiography (CAG), patients were divided into two groups: those combined with obstructive stenosis (n=24) and those without obstructive stenosis (n=20). The efficacy of medical treatment or combined stent implantation was observed, and major adverse cardiovascular events (MACE) or death were monitored during follow-up. Results There were no statistically significant differences between the group CAS combined with obstructive stenosis and the group CAS without obstructive stenosis in terms of gender, age, risk factors (hypertension, diabetes, alcohol abuse, smoking), laboratory test indicators［peak values of blood glucose (Glu), low-density lipoprotein cholesterol (LDL-C),total cholesterol］, myocardial injury markers［cardiac troponin T (cTnT), creatine kinase isoenzyme(CK-MB)］, ejection fraction (EF), and proportion of inferior wall ST segment elevation on electrocardiogram (P>0.05). Among 24 cases of spastic coronary artery complicated with obstructive stenosis, 5 cases (20.83%) were treated with drugs, and 19 cases (79.17%) underwent PCI ［15 cases (78.95%) had PCI on spastic and obstructive stenostic coronary arteries and 4 cases (21.05%) had PCI on non-spastic coronary arteries］. Among 20 cases of spastic coronary artery without stenosis, 16 cases had right coronary artery (RCA)spasm (including 13 cases had RCA completely normal with spasm, 3 cases with 20%-30% stenosis), 4 cases of left anterior descending artery (LAD) spasm (2 cases of completely normal, 2 cases with 30%-40% stenosis), and only 1 case (5.00%) underwent PCI in non-spastic coronary artery. in the group with coronary artery spasm and obstructive stenosis, the follow-up period ranged from 24 to 129 (64.13±29.80) months, with 4 cases of angina recurrence, 1 case of in-stent stenosis, and 1 case of very late stent thrombosis leading to acute myocardial infarction requiring emergency PCI. In the group without stenosis, the follow-up period ranged from 30 to 168 (64.75±32.54) months, with 7 cases of angina recurrence and 1 death. The incidence of MACE (25.00% vs 40.00%) was not statistically significant between the two groups (P＞0.05). Conclusion Patients with CAS and obstructive stenosis can choose medical treatment combined with stent implantation for good prognosis, but guidance under intracoronary imaging is necessary.
keywords: Coronary artery spasm Coronary atherosclerotic stenosis Percutaneous coronary intervention Major adverse cardiovascular events
文章编号： 中图分类号：R541.42 文献标志码：A
基金项目:2018年中石化南化公司临床医学专项科研项目（ZX18001）
引用文本：
刘丹丹，张向明，张小兵，夏思良.冠状动脉痉挛综合征合并阻塞性狭窄患者的临床特点及预后[J].中国临床研究,2024,37(8):1264-1268.
刘丹丹，张向明，张小兵，夏思良.冠状动脉痉挛综合征合并阻塞性狭窄患者的临床特点及预后[J].中国临床研究,2024,37(8):1264-1268.