变异型心绞痛患者的临床和冠状动脉造影特点分析

Study on clinical and angiographic features of patients with variant angina pectoris

目的分析变异型心绞痛(VAP)患者的临床、冠状动脉造影(CAG)特点及随访结果。方法对比分析36例VAP患者和40例稳定型心绞痛(SAP)患者的一般临床资料、CAG结果及临床随访资料。结果与SAP组比较,VAP组患者年龄较小(P<0.01),男性、吸烟、合并心律失常的比率较高(P<0.05);合并高血压、高胆固醇血症和冠状动脉狭窄病变的比率较低(P<0.05)。36例VAP患者中CAG显示有冠状动脉病变者32例(88.9%),其中固定狭窄≥50%者28例(77.8%),"正常"者仅4例(11.1%)。VAP组中下壁和后壁ST段抬高亚组24例,是前壁和高侧壁ST段提高亚组(12例)的2倍,缓慢性心律失常更多见(P<0.05)。VAP组中5例冠状动脉严重狭窄的患者接受了冠状动脉介入治疗,1例三支病变的患者接受了冠状动脉旁路移植手术治疗;所有患者均给予硝酸酯类和钙拮抗剂及冠心病二级预防治疗。36例VAP患者均完成了随访,2例患者仍偶有心绞痛发作,1例患者于出院后8个月时发生了急性下壁后壁心肌梗死,另1例患者于出院后15个月时猝死。结论 VAP患者冠状动脉痉挛可发生于CAG正常的冠状动脉,更多发生于有病变的冠状动脉;少数VAP患者即使规范药物治疗,仍有可能发生心绞痛、心肌梗死和猝死,应引起重视。

Objective To analyze the clinical and coronary angiographic features and the follow - up results in patients with variant angina pectoris （VAP）. Methods The general clinical data and coronary angiographie results and follow - up data of 36 patients with VAP and 40 patients with stable angina pectoris （SAP） were reviewed and analyzed. Results In comparison with the group of SAP, patients in group of VAP were younger in age with higher percentage of males, smoking and arrhythmia （ P 〈 0.05 ） while hypertension, hypereholesterolemla and stenotie vessels were in lower percentage （ P 〈0.05） . Coronary angiography revealed stenotic vessels in 28 patients （77.8%）, diseased vessels in 32 patients （ 88.9 % ） , and normal vessels in 4 patients （ 11.1% ）. Bradyacrhythmia was more frequently occurred in VAP subgroup with ST elevation in II, m, aVF, V7 -V9 leads than those of VAP subgroup with ST elevation in V1 -V6, I, aVF leads. Five patients received coronary interven- tion and 1 patient received coronary artery bypass graft surgery in patients of VAP group. All these patients were given with nitric acid ester and calcium antagonists and coronary heart disease secondary prevention treatment. Follow - up study was completed in all 36 patients of VAP group. During the follow - up period, 2 patients still had occasionally attacks of angina pectoris. Acute inferior myocardial infarction occurred in 1 patient at eighth month after discharged from the hospital, and sudden death had been occurred in another patient with nearly 60% segmental narrow of left anterior descending artery in 15th month. Conclusion The coronary spasm in patients of VAP group may occur in patients with normal coronary angiography, while coronary lesions occur in more of them. It usually accompany with arrhythmia. Angina pectoris, myocardial infarction and sud- den death may happen in a few of VAP patients even though they continuously applied standard therapy.