Li Bai-Ling, Li Li, Hou Xiao-Lei, He Bin, Zhang Guan-Xin, Chen Ke-Biao, Xu Zhi-Yun
Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Zhonghua Yi Xue Za Zhi. 2007 Dec 18;87(47):3313-6.
To investigate the prevalence of coronary artery disease (CAD) and the atherosclerotic risk factors in the patients undergoing valvular surgery due to rheumatic heart disease.
Consecutive 651 patients with rheumatic heart disease aged > 40 who were scheduled for valve surgery underwent diagnostic coronary angiography to delineate coronary arteries. Significant coronary artery disease was considered to be present if one or more single coronary branches showed 50% or more luminal stenosis. Symptoms, such chest pain, were evaluated. Established risk factors for CAD, such as diabetes mellitus, systemic hypertension, smoking, and dyslipidemia were evaluated. Previous history of myocardial infarction and coronary artery bypass surgery was also recorded.
Seventy-one patients (10.91%), 54 males and 17 females, were detected as with CAD. The mean age of the patients with CAD was (63 +/- 9), significantly higher than that of the patients with normal coronary arteries [(54 +/- 9), P < 0.01]. The atheromatous lesion mostly involved the left descending branch (38.12%), and 38 patients (53.52%) showed lesions in 2 or more branches. The prevalence rates of diabetes mellitus and hypertension in the CAD group were 32.39% and 29.58% respectively, both significantly higher than those in the non-CAD group (7.41% and 19.48% respectively; P < 0.01 and P = 0.047). The smoking rate of the CAD group was 36.62%, significantly higher than that of the non-CAD group (12.93%; P < 0.01). However, there were not significant differences in the prevalence rates of dyslipidemia and ECG ST-T changes between these 2 groups (both P > 0.05). No relation was found between the rheumatic disease and coronary disease distribution (P > 0.05).
Coronary angiography should be performed in all patients clinically suspected with CAD, aged > 50 and the patients with angina and/or coronary risk factors in order to decrease the occurrence of operative complications.
研究风湿性心脏病瓣膜置换手术患者冠状动脉疾病（CAD）的患病率及动脉粥样硬化危险因素。
连续纳入651例年龄>40岁、计划行瓣膜手术的风湿性心脏病患者，进行诊断性冠状动脉造影以明确冠状动脉情况。若一支或多支冠状动脉分支管腔狭窄达50%及以上，则认为存在显著冠状动脉疾病。对胸痛等症状进行评估。评估CAD的既定危险因素，如糖尿病、系统性高血压、吸烟和血脂异常。记录既往心肌梗死和冠状动脉搭桥手术史。
71例患者（10.91%）被检测出患有CAD，其中男性54例，女性17例。CAD患者的平均年龄为（63±9）岁，显著高于冠状动脉正常患者（[54±9]岁，P<0.01）。动脉粥样硬化病变主要累及左前降支（38.12%），38例患者（53.52%）有2支或以上分支出现病变。CAD组糖尿病和高血压的患病率分别为32.39%和29.58%，均显著高于非CAD组（分别为7.41%和19.48%；P<0.01和P=0.047）。CAD组吸烟率为36.62%，显著高于非CAD组（12.93%；P<0.01）。然而，两组血脂异常患病率和心电图ST-T改变差异均无统计学意义（P均>0.05）。未发现风湿性疾病与冠状动脉疾病分布之间存在关联（P>0.05）。
对于所有临床怀疑患有CAD、年龄>50岁以及有心绞痛和/或冠状动脉危险因素的患者，均应进行冠状动脉造影，以减少手术并发症的发生。
