Takahashi Junichiro, Okude Jun, Gohda Toshihiro, Murakami Taiji, Hatakeyama Mariko, Sasaki Shigeyuki, Yasuda Keishu
Division of Cardiovascular Surgery, Aishin Memorial Hospital, Hokkaido, Japan.
Ann Thorac Cardiovasc Surg. 2002 Aug;8(4):213-9.
Complication due to coronary artery disease (CAD) is a major cause of mortality in the surgical treatment of abdominal aortic aneurysm (AAA). The purpose was to show 1) the incidence of patients who required coronary artery bypass grafting (CABG), and 2) risk factors for the necessity of CABG in patients with AAA.
Subjects were consecutive 159 patients (132 males and 27 females) undergoing elective repair of non-ruptured AAA between May 1993 and March 2002. Most patients (n=145) underwent routine preoperative coronary angiography (CAG) and received coronary revascularization when necessary. Clinical atherosclerotic risk factors were subjected to univariate and multivariate analysis to determine predictors for the necessity of CABG.
Of 43 patients (27.0%) with significant coronary stenosis, 7 patients (4.4%) underwent CABG concomitantly (n=1) or prior to the AAA repair (n=6) in the same admission. Other patients received percutaneous transluminal coronary angioplasty (PTCA) (n=14) and isolated medical treatment (n=22). Overall mortality of 159 patients undergoing AAA repair was 2.5% and there were no deaths in 7 patients undergoing CABG. Univariate and multivariate analysis indicated only the history of angina as significant for the necessity of CABG in patients with AAA. Of 155 survivors, 5 patients underwent CABG later in the follow-up period.
The incidence of patients who required CABG in the treatment of AAA was 4.4% in our institute. It was difficult to predict the necessity of CABG without conducting CAG in patients with asymptomatic myocardial ischemia. These results may justify the routine enforcement of preoperative CAG in patients with AAA.
冠状动脉疾病（CAD）所致并发症是腹主动脉瘤（AAA）外科治疗中死亡的主要原因。本研究目的为：1）显示需要冠状动脉旁路移植术（CABG）的患者发生率；2）AAA患者行CABG必要性的危险因素。
研究对象为1993年5月至2002年3月期间连续接受择期非破裂性AAA修复术的159例患者（132例男性，27例女性）。大多数患者（n = 145）接受了常规术前冠状动脉造影（CAG），并在必要时接受冠状动脉血运重建。对临床动脉粥样硬化危险因素进行单因素和多因素分析，以确定CABG必要性的预测因素。
43例（27.0%）有显著冠状动脉狭窄的患者中，7例（4.4%）在同一次住院期间行AAA修复术时同时（n = 1）或之前（n = 6）接受了CABG。其他患者接受了经皮腔内冠状动脉成形术（PTCA）（n = 14）和单纯药物治疗（n = 22）。159例行AAA修复术患者的总死亡率为2.5%，7例行CABG的患者无死亡。单因素和多因素分析表明，仅心绞痛病史对AAA患者行CABG的必要性有显著意义。155例幸存者中，5例在随访期间接受了CABG。
在我们研究所，AAA治疗中需要CABG的患者发生率为4.4%。对于无症状心肌缺血患者，不进行CAG很难预测CABG的必要性。这些结果可能证明对AAA患者常规实施术前CAG是合理的。
