| IntroductionCoronary artery spasm is coronary smooth muscle reversible staggered or permeated twitchlike contraction, it' s the reason of myocardial ischemia and myocardial necrosis. It' s also lead to angina pectoris and myocardial infarction, sudden death in clinical. These years more and more data show psychological stress ,behaviorstyle are relate with coronary artery spasm. Anxiety , alarm, depressed , angry, and life events play the important risk factors in coronary artery spasm. So coronary arten' spasm is a psychosomatic disease. Psychological stress is the one of important risk factors in coronary arten' spasm. But the precisely mechanism is not difitude.It is very important clinical significence to exact test the patients of coronary arten spasm. but the types have some fatalness to test and place apremium on coronary arten spasm , so research about the the risk reasons of coronary artery spasm is very few.This research through acetylcholine place apremium on coronary artery spasm and logistic regression analysis the clinical fatalness reasons relate to coronary artery spasm.Clinical data and methods1 ,The choice of patients: the 51 patients in Liaoning province hospital and Fushun hospital from 10 -2001 to 12 -2003.28 patients were included to undertake intra coronary acetylcholine test. Adapt symptom; angina pectoris of typical and proximal but without significant coronary stenosis by coronary an-giogarphy (coronary artery stenosis under 75% ). Eliminate standard (1) ,NY-HA, III, IV ; (2) ,disease of left main trunk ; (3 ) ,syncope or patient of brady-cardia history of swoonor,A - S syndrome; (4) angina pectoris by hypertrophic .cardiomyopathy ,valvular heart disease,panic attack.2,methods: (1) ,normal Judkin method coronary artery and left ventricular angiography; ( 2 ) , prepare before test: stop Ca + + - anti and long - effect - ni-troglycerinester at least 24h, short - effect - nitroglycerinester 6h before test; (3) A project of test; the patients was be acetylcholine 10fig injected into coronary artery in 10 - 15s, and then coronary angiogarphy was done again in 3 min but without marked coronary artery spasm, angina pectoris and changes of cardiogram, and then 30 g be injected again to next 60 g be done. If coronary angiography show staggered or permeated twitchlike contraction or ischemic sinus brad-ycardia, sinus arrest changes in cardiogram that must stop inject acetylcholine and inject nitroglycerine in 150 -200 g torelieve coronary artery spasm, in the stage of test different reactions will be note; (4) ,the judge standard of coronary artery spasm: Coronary artery spasm was diagnosed when coronary artery stenosis increased to 90 % and accompanied by usual angina pectoris and/ or ischemic changes on electrocardiogram 1, angina pectoris and /or artery spasm was be catabatic after inject nitroglvcerine.3 .collect of clinical data; ( 1 ) ,questionary include age,sex occupation, and so on. meterage of psychology by SCL -90,SAS,SDS ,CES,SSRS to test patient's anxiety , alarm, depressed, angry , and life events, etc.4 .statistics dispose: logistic,t test, line regression, X2 test and SPSS were employed to analyse the relationships between coronary artery spasm and danger risks.ResultsTest group is different with antitheses (p =0. 004). LVEF haven't marked difference with LVEDP( p >0. 05). logistic show coronary artery spasm accord rate is 75% by acetylcholine . Regression analysis show that without marked difference between test of acetylcholine and other test. (such as age sex, etc)Logistic regression analysis showed that psychological stress factor makecoronary artery spasm increased by 4.2 times respectivelyn then OR. psychological stress factor is the independency risk factor in coronary artery spasm.Dicuss1 ,The appraise of coronary artery spasm was placed a premium on by ace-tylcholine;The traditional test type of place a premium on coronary artery spasm include ergot new alkali test, cool addpress test, upchange breath, etc, in these tests ergot new alk... |
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