| Objective:To explore related risk factors in myoardial bridge(MB)by observing the clinical characteristics,biochemical indexes and imaging examination of myocardial bridge(MB)and myocardial bridge complicated with coronary artery spasm(CAS),multivariate regression analysis was performed to explore the risk factors.To observe the different medications between MB and MB with CAS,evaluate the efficacy and safety of drugs,and explore the right medication options.Methods: We retrospectively analyzed 222 patients suffering from chest pain for MB,MB has been diagnosed by coronary angiography in the Department of Cardiology of Xiangtan Central Hospital from August 2016 to August 2018.According to the criteria of inclusion and exclusion,149 patients with MB were divided into two groups.The study group was characterized by the presence of resting angina pectoris and had one of the following characteristics: 1.The diameter of any one of the three main coronary arteries increased by 50% after intravascular nitroglycerin injection(200ug)during coronary angiography.2.Exercise load test reverse ischemic positive.3.Transient ST segment elevation during chest pain onset.Patients not in accordance with the above characteristics is the control group.A total of 56 cases were collected into the study group,and 93 cases were collected into the control group.Clinical characteristics,biochemical indexes and imaging examinations of the patients in the study group and the control group were compared,and multivariate regression analysis was conducted to investigate the related risk factors of CAS.In addition,the use of drugs in the study group and the control group were observed.The patients in the study group were treated with CCB(calcium channel blocker),during the hospitalization and the patients in the control group were treated with BB(? receptor blocker),patients who did not respond to BB were switched to BB+CCB treatment.There were three types of therapy were used in the out-patient department in the study group: 1.Long-term calcium channel blocker(CCB group);2.2.Beta blockers(BB group);3.Withdrawal group.There were three types of therapy used in the control group: 1.BB group.2.BB+CCB group;3.Withdrawal group.According to the relevant grouping information,We did the following things:1.Comparison of the effectiveness of treatment between the study group and the control group during hospitalization.2.Comparison of intra-group drug use proportion,effectiveness and re-admission rates in the study group during the out-patient period.3.Comparison of effectiveness of in-hospital and out-patient use of drugs in the study group.Because there were too many patients who did not continue to have therapy in our outpatient department or have drugs in the control group,the therapeutic effect of the drug was not significant,and no further study on the therapeutic effect of the drug was carried out.Result:1.The myocardial bridge was distributed in 2 cases(1.3%)at the proximal end of the left anterior descending branch,144 cases(96.6%)in the middle part of the anterior descending branch and 3 cases(2.1%)in the distal end of the anterior descending branch.2.The smoking rate in study group is 41.1%,significantly higher than that in control group(18.2%)(P < 0.001).The mean stenosis degree of study group was(47 +13)%,which was more serious than that of control group(41 +16)%.The difference was statistically significant(P< 0.05).In study group,the levels of high-sensitivity C-reactive protein(4.42 ±6.71)and neutrophil percentage(66.46 ±7.80%)were higher than those in the control group,in which the neutrophil percentage is(62.75 ±9.38%)and CRP is(0.98 ±1.32).The level of HDL(1.10 ±0.29)in the study group was lower than that of the control group(1.25 ±0.44),the dif ference was statistically significant(P < 0.05).3.Multivariate logistic regression analysis showed that smoking,degree of bridge stenosis and hypersensitive C-reactive protein were independent risk factors for myocardial bridge with coronary artery spasm.4.There was no significant difference in the total effective rate between the study group(94.6%)and the control group(96.8%)during hospitalization(P > 0.05).The total effective rate of CCB subgroup(92.0%)was higher than that of BB subgroup(60.0%)during outpatient follow-up(P < 0.05).In the study group,the re-admission rate of CCB subgroup(4.0%)was significantly lower than that of the BB subgroup(30.0%)and the withdrawal subgroup(33.3%)(P < 0.05).The total effective rate of taking CCB during hospitalization in the study group(94.6%)is much higher compared with the total effective rate of taking BB(60.0%)in the outpatient department study group,the difference was statistically significant(P < 0.05).5.There were 2 adverse events in the study group,1 non-ST elevation myocardial infarction,1 syncope,and no serious adverse events in the control group.Conclusion:1.Smoking?CRP and the degree of stenosis of mural coronary artery may be associated with the risk of myocardial bridge complicating coronary artery spasm.2.Patients with myocardial bridge complicated with coronary spasm tend to use calcium channel blockers,and attention should be paid to the prevention of adverse cardiovascular events. |
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