变异性心绞痛患者并发晕厥的相关因素分析

目的分析变异性心绞痛患者伴发晕厥的相关危险因素。方法 2003年1月至2011年03月期间我院心内科住院患者中诊断变异性心绞痛74例,根据病程中晕厥发作的有无,分为晕厥组（n=16）和非晕厥组（n=58）。对比分析两组患者的危险因素、临床特征和冠状动脉造影结果。结果 （1）与非晕厥组比较,晕厥组患者发作时恶性心律失常发生率较高（10.3%对100%,P〈0.0001）,空腹血浆低密度脂蛋白胆固醇较低（2.15±0.73mmol/L对1.68±0.45mmol/L,P=0.003）,两组患者的心血管危险因素、胸痛特点和入院前使用药物、其他实验室检查指标、左室射血分数、发作时心电图的心脏缺血部位和ST段抬高导联数目并无统计学差异。（2）冠脉造影显示,两组患者的血管病变严重程度无统计学差异;与非晕厥组比较,晕厥组患者中前降支固定性狭窄较少（34.48%对6.25%,P=0.03）,而右冠狭窄较多,但未达统计学差异（8.62%对25%,P=0.095）。（3）多因素Logistic回归分析显示恶性心律失常（P〈0.0001）和右冠状动脉狭窄（P=0.028）是变异性心绞痛患者发生晕厥的独立危险因素。结论变异性心绞痛患者并发晕厥并非少见,恶性心律失常是晕厥的直接原因。右冠状动脉固定性狭窄的患者容易发生晕厥,需要引起重视并积极干预。

Clinical Features of Variant Angina Patients with Associated Syncope

Objective To investigate the clinical features of variant angina patients with associated syncope.Methods Between January 2003 and March 2011,variant angina with typical symptom and electrocardiogram was diagnosed in 74 patients admitted to our cardiovascular department.Sixteen patients had a history of syncope during cardiac attacks while the remaining 58 had none.Cardiovascular risk factors,clinical characteristics and coronary angiographic findings were compared between the two groups.Results(1)Serious arrhythmias were recorded more often in syncope group(100%)than non-syncope group(10.3%,P<0.0001).Low-density lipoprotein cholesterol was lower in syncope group(1.68±0.45 mmol/L) than non-syncope group(2.15±0.73 mmol/L,P=0.003).There were no difference in cardiovascular risk factors,pain duration,medication,left ventricular ejection fraction,the location and extent of ST-segment elevation in 12-lead electrocardiogram.(2)Compared with the non-syncope group,syncope group had a lower incidence of left anterior descending artery(LAD)stenosis(34.48%vs 6.25%,P=0.03)and a non-significant higher incidence of right coronary artery(RCA)stenosis(8.62%vs 25%,P=0.095)in coronary angiography.(3)On multivariable Logistic analysis,serious arrhythmias(P<0.0001)and RCA stenosis(P=0.028)were independently related to syncope.Conclusion Syncope is a common complication in patients with variant angina,and serious arrhythmias is the direct trigger factor.Fixed stenosis in RCA is susceptible to syncope,and a more active intervention should be advisable for those patient.