Major racial differences in coronary constrictor response between Japanese and Caucasians with recent myocardial infarction

被引:305
作者
Pristipino, C
Beltrame, JF
Finocchiaro, ML
Hattori, R
Fujita, M
Mongiardo, R
Cianflone, D
Sanna, T
Sasayama, S
Maseri, A
机构
[1] Univ Cattolica Sacro Cuore, Ist Cardiol, I-00168 Rome, Italy
[2] Univ Adelaide, Adelaide, SA, Australia
[3] Kyoto Univ, Kyoto, Japan
关键词
vasoconstriction; vasospasm; vasodilation; myocardial infarction; acetylcholine;
D O I
10.1161/01.CIR.101.10.1102
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Enhanced coronary vasomotion may contribute to acute coronary occlusion during the acute phase of myocardial infarction (AMI). Japanese have a higher incidence of variant angina than Caucasian patients, but racial differences in vasomotor reactivity early after AMI are controversial. Methods and Results-The same team studied 15 Japanese and 19 Caucasian patients within 14 days of AMI by acetylcholine injection into non-infarct-related (NIRA) and infarct-related (IRA) coronary arteries followed by nitroglycerin. Incidence of vasodilation, vasoconstriction, spasm, and basal tone were assessed in proximal, middle, and distal segments after each drug bolus by quantitative angiography, Japanese patients had much lower cholesterol levels than Caucasians (183 +/- 59 versus 247 +/- 53 mg/dL, P<0.006) but showed a lower incidence of vasodilation (2% versus 9% of coronary segments) and a greater incidence of spasm after acetylcholine (47% versus 15% of arteries, P<0.00001). Incidence of spasm was higher in IRAs than in NIRAs in both populations (67% versus 39% and 23% versus 11%, respectively). Multivessel spasm was more common (64% versus 17%, P<0.02) and vasoconstriction of nonspastic segments was greater in Japanese patients (-23.4 +/- 14.9% versus -20.1 +/- 15.7%, P<0.02) in the presence of similar average basal coronary tone with respect to post-nitroglycerin dilation and of nonsignificant differences of coronary atherosclerotic score. Conclusions-Soon after AMI, Japanese patients exhibited a 3-fold-greater incidence of spasm and greater vasoconstriction of nonspastic segments after acetylcholine than Caucasians. The causes of such differences warrant further investigation because they may have relevant pathophysiological and therapeutic implications.
引用
收藏
页码:1102 / 1108
页数:7
相关论文
共 17 条
[1]  
AUSTEN WG, 1975, CIRCULATION, V51, P12
[2]   FREQUENCY OF PROVOKED CORONARY ARTERIAL SPASM IN 1089 CONSECUTIVE PATIENTS UNDERGOING CORONARY ARTERIOGRAPHY [J].
BERTRAND, ME ;
LABLANCHE, JM ;
TILMANT, PY ;
THIEULEUX, FA ;
DELFORGE, MR ;
CARRE, AG ;
ASSEMAN, P ;
BERZIN, B ;
LIBERSA, C ;
LAURENT, JM .
CIRCULATION, 1982, 65 (07) :1299-1306
[3]   COMPARISON OF CORONARY ANGIOGRAPHIC FINDINGS IN ACUTE AND CHRONIC 1ST PRESENTATION OF ISCHEMIC-HEART-DISEASE [J].
BOGATY, P ;
BRECKER, SJ ;
WHITE, SE ;
STEVENSON, RN ;
ELTAMIMI, H ;
BALCON, R ;
MASERI, A .
CIRCULATION, 1993, 87 (06) :1938-1946
[4]   RESPONSES OF ATHEROSCLEROTIC HUMAN CORONARY-ARTERIES INVIVO TO THE ENDOTHELIUM-DEPENDENT VASODILATOR SUBSTANCE-P [J].
CROSSMAN, DC ;
LARKIN, SW ;
DASHWOOD, MR ;
DAVIES, GJ ;
YACOUB, M ;
MASERI, A .
CIRCULATION, 1991, 84 (05) :2001-2010
[5]   THROMBOSIS AND ACUTE CORONARY-ARTERY LESIONS IN SUDDEN CARDIAC ISCHEMIC DEATH [J].
DAVIES, MJ ;
THOMAS, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1984, 310 (18) :1137-1140
[6]   THE OBLIGATORY ROLE OF ENDOTHELIAL-CELLS IN THE RELAXATION OF ARTERIAL SMOOTH-MUSCLE BY ACETYLCHOLINE [J].
FURCHGOTT, RF ;
ZAWADZKI, JV .
NATURE, 1980, 288 (5789) :373-376
[7]  
FUSTER V, 1992, NEW ENGL J MED, V326, P310
[8]   INTERMITTENT CORONARY-OCCLUSION IN ACUTE MYOCARDIAL-INFARCTION - VALUE OF COMBINED THROMBOLYTIC AND VASODILATOR THERAPY [J].
HACKETT, D ;
DAVIES, G ;
CHIERCHIA, S ;
MASERI, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1987, 317 (17) :1055-1059
[9]   PATHOGENETIC MECHANISMS OF CORONARY-ARTERY SPASM [J].
MASERI, A ;
KASKI, JC .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (03) :610-612
[10]   CORONARY VASOSPASM AS A POSSIBLE CAUSE OF MYOCARDIAL-INFARCTION - CONCLUSION DERIVED FROM STUDY OF PREINFARCTION ANGINA [J].
MASERI, A ;
LABBATE, A ;
BAROLDI, G ;
CHIERCHIA, S ;
MARZILLI, M ;
BALLESTRA, AM ;
SEVERI, S ;
PARODI, O ;
BIAGINI, A ;
DISTANTE, A ;
PESOLA, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1978, 299 (23) :1271-1277