冠状动脉痉挛心绞痛患者临床特点与介入治疗

Clinical characteristics and interventional therapy in patients with coronary artery spasm angina

目的分析冠状动脉痉挛心绞痛患者的临床特点及介入治疗后效果。方法收集2010年1月至2018年4月资料完整的27例冠状动脉痉挛心绞痛患者,对其临床特点及介入治疗情况进行回顾性分析。结果27例患者中夜间凌晨心绞痛发作16例(59.26%);在心绞痛发作时经体表心电图或动态心电图确认下壁导联ST段抬高16例(59.26%)。27例患者均行冠状动脉造影检查,痉挛冠状动脉显著狭窄11例(40.74%);痉挛冠状动脉无显著狭窄16例(59.26%)。痉挛冠状动脉显著狭窄11例中,6例行经皮冠状动脉介入治疗(PCI),痉挛冠状动脉均为右冠状动脉(RCA)(5例在高度狭窄的左前降支中植入支架,另1例在左回旋支植入支架),其中有4例在PCI后才证实心绞痛由非PCI冠状动脉痉挛引起。痉挛冠状动脉无显著狭窄组与有显著狭窄组,在年龄,血脂(LDL-C水平),高血压、吸烟、糖尿病等危险因素,心电图ST段抬高部位等方面差异无统计学意义(P>0.05)。所有患者住院期间在控制危险因素的基础上均使用硝酸酯类、钙通道阻滞剂,其中23例患者心绞痛在住院期间得到良好控制,4例出院后1个月仍心绞痛发作,加用尼可地尔才得到控制。结论冠状动脉痉挛心绞痛多见于无显著狭窄的RCA,治疗以药物控制为主。

Objective To analyze the clinical characteristics and the effect of interventional therapy in patients with coronary artery spasm(CAS)angina.Methods Based on the complete information of 27 patients with vasospastic angina(VSA)from January 2010 to April 2018,the clinical characteristics and interventional therapy were analyzed retrospectively.Results There were 16(59.26%)cases of angina attack at midnight and 16(59.26%)cases of inferior wall ST segment elevation during angina attacks confirmed by body surface electrocardiographic(ECG)or dynamic ECG.Coronary angiography showed significant stenosis in 11 patients(40.74%)and no obvious stenosis in 16 patients(59.26%).In 11 cases with significant stenosis,6 cases of right coronary artery(RCA)stenosis were treated by PCI,including 5 cases with stents implanted in the left anterior descending artery and 1 case in the left circumflex branch.In 4 cases after PCI,angina pectoris were confirmed not to result from the coronary spasm with PCI.There were no statistical differences in age,blood lipid(LDL-C),incidences of hypertension,smoking,diabetes and ST segment elevation of ECG between the patients with obvious stenosis and the patients without significant stenosis(P>0.05).All patients received calcium channel blockers and nitrate on the basis of controlling risk factors,and angina pectoris was well controlled in 23 patients during hospitalization.One month after discharge,there were 4 patients with angina attacks which were controlled when nicorandil was added.Conclusions Coronary spasm angina is more common in the patients with RCA without significant stenosis and is mainly controlled by drugs.