Clinical Analysis Of Coronary Artery Spasm

Background:With the extensive development of coronary angiography,we found that10%to 15%of patients with acute myocardial infarction had no significant abnormalities of coronary angiography and were caused by some non-atherosclerotic diseases,among which the coronary artery spasm（CAS）occupied a large proportion,and relative to patients with atherosclerotic lesions,the prognosis is better.However,its etiology and pathogenesis are still not fully understood.Objective:To investigate the risk factors for angina pectoris and myocardial infarction caused by CAS,and provide basis for clinicians to identify CAS early and interfere with it.Methods:This study used a retrospective analysis method to collect general clinical data,susceptibility factors,biochemical indicators,imaging examinations,treatment methods and outcomes of 71 patients with coronary artery spasm who were hospitalized from January 2012 to August 2017.The positive ratios of various clinical data were counted and analyzed.The clinical data of 40 patients with coronary atherosclerotic heart disease in our hospital were collected and compared with the CAS group.Statistical methods were used for analysis.Patients with typical CAS were selected and OCT was applied to further understand the coronary artery spasm.Results1.Gender difference:A total of 61 male patients aged 22 to 80 years,an average of52.34±11.53 years;a total of 10 female patients aged 43 to 81 years with an average of62.40±13.29 years.The ratio of male to female was about 6:1,and the incidence of male CAS was more than female,and the difference was statistically significant（P=0.015）.2.Clinical data analysis:The proportion of smoking（47/71,accounting for 66.2%）and drinking（50/71,accounting for 70.4%）in CAS patients was significantly higher,followed by:hypertension（36/71,accounting for 50.7%）,surgery history（15/71,accounting for 21.1%）,allergies（8/71,accounting for 11.3%）,and diabetes（4/71,accounting for 5.6%）.The main causes of CAS were physical labor（14/71,accounting for 19.7%）and nervous mood and staying up late（12/71,accounting for16.9%）.The main clinical manifestations of CAS patients were chest pain（55/71,accounting for 77.5%）,chest tightness（13/71,accounting for 18.3%）,fainting（3/71,accounting for 4.2%）,abdominal pain（1/71,accounting for 1.4%）.The main abnormalities in laboratory tests of CAS patients were elevated TG（25/60,accounting for 41.7%）,elevated TC（16.7%,accounting for 10/60）,and elevated LDL-C（18/60,accounting for30%）,NEU increased（19/71,accounting for 26.8%）,CK increased（14/68,accounting for20.6%）,CK-MB increased（9/68,accounting for 13.2%）,BNP increased（16/39,accounting for 41%）,TnI/TNT-hs increased（23/66,accounting for 34.8%）.Electrocardiographic findings were mainly T-wave or ST-T changes（26/59,accounting for44.1%）and acute myocardial infarction（11/59,accounting for 18.6%）.Coronary angiography showed that coronary spasm mainly occurred in the LAD segment（31/71,accounting for 43.7%）and the RCA segment（40/71,accounting for 56.3%）.Patients with mild coronary atherosclerosis after complete relief of spasm（21/71,29.6%）,no obvious stenosis but endometriosis（17/71,accounting for 23.9%）,and normal subjects（33/71,accounting for 46.5%）,with myocardial bridge（12/71,accounting for 16.9%）.Clinical medicine use of CAS patients included aspirin（51/71,accounting for 71.8%）,clopidogrel（11/71,accounting for 15.5%）,statins（58/71,accounting for 81.7%）,and ACEI drugs（31/71,accounting for 43.7%）,βblockers（31/71,accounting for 43.7%）,calcium channel blockers（51/71,accounting for 71.8%）,and nitrates（35/71,accounting for 49.3%）,etc.3.Compared with coronary heart disease patients,CAS groups in age,diabetes history,history of hypertension,heart failure,RBC,HB,CRE,CK,CK-MB,TC,APOA,BNP,TNT-hs,differences in the two groups was statistically significant（P<0.05）,while in surgical history,history of allergies,WBC,N,PLT,Ca²⁺,K⁺,ALT,AST,TBIL,TBA,ALB,TG,HDL-C,LDL-C,APOB,differences in the two groups has no statistical significance.4.Clinical prognosis:CAS and coronary heart disease were followed up for 6 to 12months.The patients in the CAS group mainly took calcium antagonists and/or nitrates,and 36 patients improved or relieved after taking the drugs（36/38,accounting for 94.7%）.In addition,one patient with malignant arrhythmia induced by right coronary spasm was successfully treated after cardiopulmonary resuscitation.Coronary heart disease group mainly took statin and aspirin and other drugs,in which 21 cases improved or relieved symptoms among 29 patients without PCI treatment（21/29,accounting for 72.4%）and 8patients had no obvious improvement in symptoms,no deaths.Conclusion1.Old age,male,smoking and hyperlipidemia are important predictors of coronary artery spasm.Drinking is associated with coronary spasm.History of allergy,surgical history,and coronary spasm are correlated.2.Diabetes and hypertension are not the influencing factors of coronary artery spasm,revealing the different pathogenesis of coronary artery spasm and coronary heart disease.3.Patients often have symptoms such as chest pain and chest tightness,people who are mainly affected by fainting should be wary.4.Calcium channel blockers,nitric acid esters and statins are recommended for the treatment of coronary spasm,and antiplatelet agents are recommended for patients with coronary artery spasm with atherosclerotic stenosis.5.Electrocardiogram showed myocardial infarction,the recurrence of angina,recurrent myocardial infarction,major cardiovascular adverse events than the incidence of patients with no myocardial infarction was higher.6.Coronary spasm can cause malignant arrhythmias or sudden cardiac death risk and should be guarded.