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Kokyu to Junkan Volume 38, Issue 9 （September 1990）

呼吸と循環 38巻9号（1990年9月発行）

Japanese English

研究

急性心筋梗塞と狭心症とのPTCAによる冠状動脈の反応性の違い Distinctive response of coronary artery compared acute myocardial infarction with angina pectoris associated with angioplasty 佐藤哲也 ¹ , 佐藤光 ¹ , 立石博信 ¹ , 内田俊明 ¹ , 土手慶五 ¹ Tetsuya Sato ¹ , Hikaru Sato ¹ , Hironobu Tateishi ¹ , Toshiaki Uchida ¹ , Keigo Dote ¹ ¹社会保険広島市民病院内科 ¹Department of Cardiology, Hiroshima City Hospital キーワード： PTCA（Percutaneous Transluminal Coronary Angioplasty） , 急性心筋梗塞（acute myocardial infarction） , 冠状動脈の反応性（response of coronary artery） Keyword: PTCA（Percutaneous Transluminal Coronary Angioplasty） , 急性心筋梗塞（acute myocardial infarction） , 冠状動脈の反応性（response of coronary artery） pp.887-892

発行日 1990年9月15日 Published Date 1990/9/15

DOI https://doi.org/10.11477/mf.1404910011

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Abstract 文献概要
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　狭心症（AP）と急性心筋梗塞（AMI）の責任枝完全閉塞例，不完全閉塞例との冠狭窄形態の違い，およびPTCAによる拡張性，合併症の違いを比較検討した。対象は，PTCAを施行した203例224枝である。これらをAP群（G1）113枝，AMIの責任枝完全閉塞群（G2）79枝，不完全閉塞群（G3）32枝の3群に分類し対比した。狭窄病変の拡張性はG1　56％，G2　81％，G3　78％とG2，G3はそれぞれG1より有意に良好に拡張した。また狭窄病変の形態を，Ambroseの分類を参考にし，concentricsmooth borderをsmooth, eccentric irregular borderおよびmultiple irregular borderをirregularとすると，G1ではirregularが113枝中72枝，G2およびG3では69枝中60枝で，後者に有意に多かった。また急性冠閉塞を含む急性冠血流障害は，G1　8％，G2　9％，G3　38％とG3で有意に多かった。以上よりAPとAMIの特に不完全閉塞例とは，冠状動脈の反応性に違いがあると推察された。

There has been much controversy over the mech-anism of successful percutaneous transluminal coro-nary angioplasty (PTCA). To examine clinical and angiographic factors that might be related to a suc-cessful PTCA, we assessed 224 branches treated with emergent or elective angioplasty in evolving acute myocardial infarction (AMI) and angina pectoris (AP).

The patients were divided into three groups; group 1(G1): AP (n=113), group 2 (G2): AMI with complete obstruction of infarct-related artery (IRA) (n=79), group 3 (G3): AMI with incomplete obstruc-tion of IRA (n=32). The morphology of stenotic lesion was classified into smooth type and irregular type. The former shows concentric smooth border, the latter shows eccentric irregular border and mul-tiple irregular border according to the Ambrose classification.

Regarding the severity of the stenosis immediately after successful PTCA, there was no significant differences between G2 and G3, however in G1 it was significantly higher than in other groups (G1 vs G2 vs G3, 56% vs 81% vs 78%, p＜0.001). Ir-regular type at stenotic lesions before PTCA were present in 72 of 113 branches in G1 vs 60 of 69 in G2 and G3. Regarding the incidence of acute coro-nary obstruction during PTCA, there was no signifi-cant differences between G1 and G2. However, in G3 it was significantly higher than in other groups (G1 vs G2 vs G3, 8% vs 9% vs 38%, p＜0.001).

These results suggest that the dilatation associatedwith PTCA and the morphology of stenotic lesion during evolving AMI differ from those associated with AP, and acute coronary obstruction is fre-quent in patients with AMI with incomplete ob-struction of IRA.