多支冠状动脉疾病患者的血管特征

Vascular profile of patients with multivessel coronary artery disease.

作者信息

Rigatelli Gianluca, Rigatelli Giorgio

机构信息

Endocardiovascular Therapy Research, Via T. Speri 18, 37040 Legnago, Verona, Italy.

出版信息

Int J Cardiol. 2006 Jan 4;106(1):35-40. doi: 10.1016/j.ijcard.2004.12.063.

DOI:10.1016/j.ijcard.2004.12.063

PMID:16321663

Abstract

PURPOSE

Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global management of patients with known coronary artery disease (CAD). We sought to retrospectively evaluate the clinical relevance of significant subclavian artery stenosis (SAS) and abdominal vessel stenosis or aneurysm (AVA) in patients undergoing coronary angiography.

SUBJECTS AND METHODS

Medical records of consecutive patients underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients underwent coincident diagnostic abdominal aorta angiography to evaluate abdominal vessels or subclavian angiography on the basis of clinical and angiographic criteria were analyzed.

RESULTS

During the study period, 724 consecutive patients (535 males, mean age 68.1+/-11 years) were enrolled (Table 2): a significant atherosclerotic disease of at least one arterial segments were observed in 198 patients (27.3%). Angiographically significant SAS was observed in 18/220 patients (8.1%) undergoing concomitant subclavian artery angiography and candidates to coronary surgery using the internal mammary artery. Ten patients with subclavian artery stenosis and upper limb ischemia underwent subclavian artery angioplasty and stenting and bypass surgery using LIMA. AVA were reported in 180 (35.7%) of 504 consecutive patients: renal artery stenosis was found in 13.1% of cases (66 patients), aortoiliac artery disease in 13.7 % (69 patients), and aortic aneurismal disease in 8.9% (45 patients). Logistic regression analyses revealed > or =3-vessel CAD (odds ratio [OR] 9.917, p=0.002), age>60 years old (OR 3.817, p=0.036), > or =3 risk factors (OR 2.8, p=0.048) as independent predictors of SAS and AVA.

CONCLUSION

Patients with multivessel CAD are frequently aged, have an high risk profile and multiple vascular atherosclerotic distributions, suggesting the usefulness of a more global and comprehensive cardiovascular approach.

摘要

目的

外周动脉粥样硬化的早期准确诊断对于已知冠状动脉疾病（CAD）患者的整体管理至关重要。我们旨在回顾性评估接受冠状动脉造影的患者中严重锁骨下动脉狭窄（SAS）和腹部血管狭窄或动脉瘤（AVA）的临床相关性。

对象与方法

对在两家公共机构连续12个月接受冠状动脉造影的患者的病历进行评估。分析了根据临床和血管造影标准接受同期诊断性腹主动脉造影以评估腹部血管或锁骨下动脉造影的患者的血管造影结果。

结果

在研究期间，纳入了724例连续患者（535例男性，平均年龄68.1±11岁）（表2）：198例患者（27.3%）观察到至少一个动脉节段存在严重动脉粥样硬化疾病。在220例接受同期锁骨下动脉造影且准备使用乳内动脉进行冠状动脉手术的患者中，18例（8.1%）观察到血管造影显示的严重SAS。10例锁骨下动脉狭窄且上肢缺血的患者接受了锁骨下动脉血管成形术、支架置入术以及使用左乳内动脉的搭桥手术。在504例连续患者中，180例（35.7%）报告存在AVA：13.1%的病例（66例患者）发现肾动脉狭窄，13.7%（69例患者）存在主髂动脉疾病，8.9%（45例患者）存在主动脉瘤疾病。逻辑回归分析显示，三支或以上血管CAD（优势比[OR]9.917，p = 0.002）、年龄>60岁（OR 3.817，p = 0.036）、三个或以上危险因素（OR 2.8，p = 0.048）是SAS和AVA的独立预测因素。