急性心肌梗死与稳定性心绞痛患者电子束CT冠状动脉钙化的比较研究

Comparison of coronary artery calcification detected by electron beam computed tomography in acute myocardial infarction and stable angina pectoris

目的 比较急性心肌梗死 (AMI)与稳定性心绞痛 (SAP)患者电子束CT冠状动脉钙化(CAC)的不同模式。方法 5 5例AMI患者与 6 7例SAP患者分别行选择性冠状动脉造影以检测粥样硬化狭窄的程度 ,行电子束CT检查以计算CAC积分 ,分析SAP与AMI患者CAC积分的差异及其与年龄的关系。结果 (1)就心脏整体而言 ,SAP组CAC检测阳性率为 87 7% ,而AMI组阳性率为5 5 9% ;SAP组心脏整体和冠状动脉分支的CAC阳性率均显著高于AMI组 (P <0 0 1)。 (2 )SAP组CAC积分显著高于AMI组 ,其自然对数转换值 [LN(钙化积分 +1) ]的均数按心脏整体计算为 5 2±1 7对 2 4± 1 8(P <0 0 1) ,按冠状动脉分支计算为 3 3± 2 1对 1 2± 1 4 (P <0 0 1)。 (3)SAP组CAC程度随年龄增加而加重的趋势较AMI组更为明显 ;在每一相同的年龄段内比较 ,SAP组的CAC程度均较AMI组明显增高。 (4)SAP组重度狭窄的冠状动脉多发生重度或中度钙化 ,而AMI组梗死相关动脉则多数无钙化或仅有轻度钙化。结论 SAP患者CAC大多较为严重 ,而AMI患者多数钙化程度较轻 ,且大多发生于无或轻微钙化的冠状动脉。

Objective To compare the different patterns of coronary artery calcification (CAC) detected by electron beam computed tomography in acute myocardial infarction (AMI) and stable angina pectoris(SAP) Methods Sixty seven patients with SAP and 55 patients with AMI were examined by electron beam computed tomography to calculate calcium score (CS), and selective coronary angiography were performed to determine atherosclerotic stenosis The differences of CS in patients with SAP versus AMI and the correlation between CS and age were separately analyzed in two groups Results (1) For the heart as a whole, the positive percentages of CAC in SAP versus AMI patients were 100% and 83 64%( P <0 01), and for individual arteries, 87 69% and 55 91%, respectively ( P <0 01) (2) The natural logarithm transformation of CS were 5 24±1 72 in SAP versus 2 45±1 80 in AMI by whole heart( P <0 001) (3) The tendency that extent of CAC is increasing with aging was more apparent in SAP group than in AMI group If compared at the same age, the patients with SAP usually had more extensive calcium deposits than those with AMI (4) Severe coronary stenosis (defined as maximal percent diameter reduction ≥75%) in SAP group most often occurred in extensively or intermediately calcified coronary arteries, whereas most infarct related arteries had no calcification or mild calcification Conclusion Utilizing electron beam computed tomography, we demonstrate that the severity of coronary calcium is greater in patients with SAP than those with AMI, and the infarct related arteries are often not or mildly calcified