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医学翻译-一项冠状动脉粥样硬化的前瞻性自然史研究

发布者:鑫达医学翻译 发布时间:2011-02-12阅读:

原文:

Title: A Prospective Natural-History Study of Coronary Atherosclerosis
Author: Gregg W. Stone, Akiko Maehara, and Alexandra J. Lansky et al
N Engl J Med 2011;364:226-35.
Background
Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood.
Methods
In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years.
Results
The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm2 or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P = 0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001).
Conclusions
In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography.


译文:
题目:一项冠状动脉粥样硬化的前瞻性自然史研究
作者:Gregg W. Stone, Akiko Maehara与Alexandra J. Lansky等
N Engl J Med 2011;364:226-35.
背景
血管造影显示轻度冠状动脉狭窄的部位常发生导致急性冠脉综合征的动脉粥样硬化斑块。目前,其病变相关危险因素尚不明确。
方法
在一项前瞻性研究中,697例急性冠脉综合征患者在经皮冠状动脉介入术后接受三支血管冠状动脉造影、灰阶超声造影及射频血管内超声造影检查。判断主要不良心血管预后(包括心因性死亡、心脏停搏、心肌梗死,或因不稳定或进行性心绞痛再次住院等)与初始治疗(肇事)病变或未治疗(非肇事)病变相关。随访周期中位数为3.4年。
结果
3年累计主要不良心血管事件的发生率为20.4%。判断其与部分患者(12.9%)的肇事病变有关,与部分患者(11.6%)的非肇事病变相关。导致随访期事件的大多数非肇事病变,在基线时显示轻度血管造影 [狭窄部位的平均直径为32.3%±20.6%]。但多元分析显示,与复发性事件无关的非肇事病变相比,具有以下特征的与复发性事件相关的非肇事病变可能性更高:斑块负担≥70% [风险比为5.03;95%可信区间(CI),2.51~10.11;P<0.001),最小管腔面积≤4.0 mm2(风险比为3.21;95%CI,1.61~6.42;P = 0.001),或据射频血管内超声列为薄帽纤维粥样斑(风险比为3.35;95%CI,1.77~6.36;P<0.001)。
结论
在因急性冠脉综合征就诊并实施经皮冠状动脉介入术的患者中,随访期间主要不良心血管事件在肇事病变部位与非肇事病变部位复发的几率相当。虽然导致非预期事件的非肇事病变往往血管造影显示为轻度,但灰阶和射频血管内超声检查表明,这些病变大多是薄帽纤维粥样斑,或以斑块负担大、管腔面积小,或者部分病变综合了上述特征。
 


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