血栓溶解療法後の慢性期に残存狭窄が改善を示す急性心筋梗塞症例の特徴
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Although reperfusion of myocardial infarction by thrombolytic therapy is now widely used to limit infarct size, preserve left ventricular function and improve survival, residual stenosis leading to the recurrence of infarction and serious hemorrhagic episodes are two major complications of this treatment. Angioplasty affords higher acute reperfusion rates with lower residual stenoses than thrombolytic therapy. With the increasing use of coronary angioplasty, the decision to dilate a residual stenotic lesion in an infarct-related vessel is controversial. On the other hand, some patients show marked regression of coronary stenoses after thrombolytic therapy administered during the chronic phase. We reviewed the clinical and angiographic feature of such patients at our hospital, and analyzed the features related to rapid regression of a stenotic lesion following thrombolytic therapy. We evaluated and followed-up 122 patients who underwent coronary thrombolysis and who showed residual stenosis in their acute phase. In the chronic phase, 34 patients (28%; group R) showed the disappearance of significant stenosis of the infarct-related artery (50% or less of the lumen diameter). The remaining 88 patients (72%; group N) showed significant stenosis of their infarct-related artery (75% or more) in the chronic phase or the recurrence of angina, which required balloon angioplasty. We compared the clinical and angiographic features of the two groups. The group R patients were significantly younger than those in group N (56 vs 62 years; p< 0.01). In group R, 70% of the patients had no preinfarction angina. In contrast, 81% of group N patients had cautionary angina in the preinfarction period (p<0.01). Only 6% of the culprit lesions were calcified in group R, but 20% were calcified in group N (p<0.05). Before coronary thrombolysis, the thrombus type of occlusion was observed more frequently in group R than in group N (65% vs 33%; p<0.01). Immediately after coronary thrombolysis, type-2 eccentric lesions were more frequent in group R than in group N (59% vs 14%: p<0.01). In conclusion, a younger age, the absence of preinfarction angina, thrombus type of obstruction and a type-2 eccentric lesion without calcification are related to regression of the infarctrelated artery after coronary thrombolysis.
- 東京女子医科大学の論文
- 1996-11-25
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