冠状动脉支架置入术是急性冠状动脉综合征患者变异型心绞痛时的一种治疗手段

如果不存在或仅有轻度的器质性冠状动脉狭窄，临床上通常应用大剂量的钙阻断剂及硝酸酯类药物治疗冠状动脉痉挛所致心绞痛，而该疗法对于5％～30％的此类患者无效。纳入了5例有变异型心绞痛表现的急性冠状动脉综合征患者，这些患者接受常规药物治疗无效，对冠状动脉内注射硝酸甘油治疗亦无反应。在冠状动脉痉挛部位成功置入了支架。术后观察结果显示，早期充分的冠状动脉介入治疗能够有效地预防急性心肌梗死发生。1例患者于有临床症状出现12h后才置入支架，发生了伴有病理性Q波和心肌酶学改变的急性心肌梗死；而其他在冠状动脉痉挛引发临床症状后立刻置入支架的患者，冠状动脉痉挛未导致心肌损伤，未发现心肌梗死的临床表现及生化证据。

Coronary artery stent placement as a treatment of acute coronary syndrome in course of variant angina

High doses of calcium antagonists and nitrates are the treatment of choice in vasospasm angina when no stenosis or mild stenosis is present. In ca. 5- 30% patients this kind of treatment is not effective. We present five cases of variant angina with acute coronary syndrome in patients despite standard pharmacological treatment. These patients also did not respond for intracoronary nitroglycerine injection. They were successfully treated with stent implantation in place of vasospasm. Our observations indicate that early enough interventional treatment prevent myocardial infarction. In one case in which stent placement was performed 12 h after clinical manifestation myocardial infarction with Q waves and enzymes release occurred. In others, accurately treated with stent implantation, coronary spasm did not produce myocardial damage. We did not see any clinical and biochemical evidence of myocardial infarction.