臨床像および冠動脈造影所見からみた原発性冠動脈解離の頻度および成因について

Primary coronary artery dissection:Its incidence and genesis studied by clinical and coronaryb angio-graphic findings

　冠動脈自体に原因を有する原発性冠動脈解離の頻度および成因を臨床像や冠動脈造影所見から検討した。冠動脈造影を施行した連続5,400例中23例（0.4％）に解離を認めた。男女比は16：7であった。受診の契機となった疾患は心筋梗塞17例，狭心症6例であった。冠危険因子のうち喫煙の習慣があるものが16例（70％）存在した。解離部位は，右冠動脈12例．左前下行枝10例，左回旋枝1例であった。いずれも冠動脈分枝の近位部に病変が存在した。冠解離の枝以外の分枝に有意な器質的狭窄を認めた例は7例あり，他は“1枝疾患”であった。5例にPTCA，1例にCABG，他の17例は保存療法を施行した。1例の癌死を除き，全例経過良好である。症例は成因の面から検討して，①内分泌的異常が示唆される分娩期や閉経直後の女性群，②冠動脈攣縮の関与が示唆される群および③冠動脈の粥状硬化の一形態であることが示唆される群に大別された。このうち，③の頻度が圧倒的に多かった。

The incidence and genesis of primary coronary artery dissection which occurred spontaneously in the coronary artery system were elucidated in this study. We examined clinical and coronary angio-graphic features of the patients who presented this dissection. Primary coronary artery dissection was observed in 23 (0.43%) of 5,400 consecutive patients with ischemic heart disease undergoing coronary angiography. The basic diseases were myocardial infarction in 17 cases and angina pectoris in 6. Sixteen patients (70%) had smoking habits, which might be related to this disease. The dissec-tion of the right coronary artery in 12 cases, of the left anterior descending artery in 10, and of the left circumflex artery in only one was found. All lesions occurred in the proximal positions of the coronary branches. Seven (30%) of all cases had fixed coronary stenosis in other coronary branches. The other cases had “one-vessel” disease. Seventeen patients were treated medically, 5 had PTCA the-rapy and one had CABG operation. All the patients, except one who died of cancer are surviving in a 3.8-year follow-up. Patients can be divided etiologi-cally into three groups. The first was comprised of those in the post- or peri-partum period. The second was those associated with coronary vasospasm, and the third was those with atherosclerotic coronary artery disease. The third group was the most frequent.