不稳定性心绞痛冠状动脉造影病变与临床的相关性

目的：分析不稳定性心绞痛（UA）临床表现，心电图与冠状动脉（冠脉）造影病变形态的关系。确定不稳定性病变及住心院心脏事件的临床预测因子，方法：选择冠脉造影异常（血管狭窄≥50％）的住院UA病人120例，观察不同Braunwald分级病人造影病变形态等的发生率，评估心电图ST段异常对复杂病变、住院心脏事件等的预测价值。结果：复杂病变的检出率Ⅲ级（20／33例）最高，较Ⅰ级（13／43例）差异有显著性（P＜0．05），血栓的检出率Ⅲ级（6／33例）亦高于Ⅰ、Ⅱ级，与Ⅱ级（1／44例，2％）比较差异有显著性（P＜0．05）。住院心脏事件发生率Ⅲ级明显高于Ⅰ级（58％与195，P＜0．01）与Ⅱ级（58％与25％，P＜0．01）。Logistic回归分析示，心电图ST段异常及BraunwaldⅢ级均能预测复杂病变的存在（P＜0．01，OR为4．9；P＜0．01，OR为3．3），心电图异常能预测三支病变（P＜0．01，OR为3．9）和心脏事件（P＜0．01，OR为4．8）。结论心电图ST段异常及48h内发作的静息心绞痛对复杂病变有预测价值。ST段异常的病人，三支血管病及发生心脏事件的危险性高。

Correlation of coronary angiographic morphology with clinical presentation in unstable angina

OBJECTIVE: To seek the relation between clinical presentation (Braunwald classification) or electrocardiogram(ECG) and angiographic morphology in patients with unstable angina (UA) and to determine which clinical markers could reliably predict unstable lesions and in-hospital cardiac events. METHODS: 120 hospitalized patients with a clinical diagnosis of UA and an abnormal angiograms(>or=50% diameter stenosis) were selected. Patients were classified according to Braunwald criteria before cardiac catheterization was performed. Coronary arteriograms were reviewed. The lesion morphology (including simple lesion, complex lesion and intracoronary thrombus [ICT]) and in-hospital events (including acute myocardial infarction,cardiac death and prompt revascularization) were observed. Logistic regression was used to evaluate the ability of clinical markers (Braunwald classification or an abnormal ST segment of ECG) to predict unstable lesions and cardiac events. RESULTS: There were more complex lesions in class III group(61%, or 20 of 33) than in class I group(30%, or 13 of 43, P < 0.05) and more ICT in class III group(18%, or 6 of 33) than in class II group (2%, or 1 of 44, P < 0.05).The rate of cardiac events was higher in class III patients (58%, or 19 of 33) than in class I patients (19%, or 8 of 43, P = 0.01 ) or class II patients (25%, or 11 of 44, P < 0.01). Logistic regression analysis demonstrated that an abnormal ST segment of ECG or Braunwald class III were highly predictive of the presence of complex lesion morphology (P < 0.01, OR 4.9; P < 0.01, OR 3.3, respectively). An abnormal ECG was the single predictive clinical indicator of triple vessel disease (P < 0.01, OR 3.9) and cardiac events (P < 0.001, OR 4.8). CONCLUSION: Complex lesion can be best identified by the clinical feature of recent onset refractory angina at rest and abnormal ST segment of ECG in UA patients. Patients with abnormal ST segment represents a high risk of triple vessel disease and cardiac events.