冠状动脉疾病患者的冠状动脉外多血管粥样硬化性疾病。

Polyvascular extracoronary atherosclerotic disease in patients with coronary artery disease.

机构信息

Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, The John Paul II Hospital, Krakow, Poland.

出版信息

Kardiol Pol. 2009 Aug;67(8A):978-84.

PMID:19784902

Abstract

BACKGROUND

Cardiovascular diseases are the number one killer in the developed countries, accounting for approximately half of all deaths, with the leading causes being myocardial infarction and ischaemic stroke. In line with the ageing population, the prevalence of coronary artery disease (CAD), lower extremity peripheral arterial disease (PAD), supra-aortic arterial disease (SAD) and renal stenosis (RAS) is increasing. Polyvascular atherosclerosis (PVA) coexisting in several territories has an adverse effect on cardiovascular morbidity and mortality.

AIM

To determine prevalence, coexistence and predictors of significant PAD, SAD and RAS in patients with suspected CAD.

METHODS

Based on angiography, the frequency of coexisting CAD, SAD, PAD and RAS (stenosis > or =50%) was determined in 687 (487 male) consecutive patients, aged 63.5 +/- 9.1 years, referred for coronary angiography.

RESULTS

Significant CAD was found in 545 (79.3%) patients (1-vessel in 164; 2-vessel in 157; 3-vessel in 224). SAD, RAS and PAD were found in 136 (19.8%), 55 (8%), and 103 (15%) patients, respectively. Of the 545 patients with confirmed CAD, 346 (63.5%) had stenoses limited to coronary arteries. 2-, 3- and 4-level PVA was found in 130 (23.8%), 61 (11.2%) and 8 (1.5%) patients, respectively. Of the 142 patients without CAD, 127 (89.4%) had no significant stenoses elsewhere, 12 (8.5%) had 1 extracoronary territory and 3 (2.1%) had 2-territory involvement. Backward stepwise binary logistic regression analysis showed the following independent predictors of at least 2-level PVA: 2- and 3-vessel CAD (p < 0.001), hyperlipidaemia (p = 0.067), smoking (p < 0.001), creatinine level > or = 1.3 ml/dl (p < 0.001), lower extremities claudication (p < 0.001) and female gender (p = 0.003). The relative risk of having at least 2-territory PVA was 15.7-fold higher in patients with claudication, 2.1-fold in patients with multivessel CAD, 2.8-fold for serum creatinine level > 1.3 mg/dl; and 1.9-fold, 2.4-fold and 2-fold in patients with hyperlipidaemia, smokers and women, respectively.

CONCLUSIONS

Significant atherosclerosis in extracoronary arterial territories is present in 36% of patients with documented CAD. With advancing PVA, accumulation of atherosclerosis risk factors, previous atherothrombotic events and more severe CAD is observed.

摘要

背景

心血管疾病是发达国家的头号杀手，约占所有死亡人数的一半，其主要病因是心肌梗死和缺血性中风。随着人口老龄化，冠状动脉疾病（CAD）、下肢外周动脉疾病（PAD）、主动脉上部动脉疾病（SAD）和肾动脉狭窄（RAS）的患病率正在上升。几种部位并存的多血管粥样硬化（PVA）对心血管发病率和死亡率有不利影响。

目的

确定疑似 CAD 患者中存在显著 PAD、SAD 和 RAS 的患病率、共存情况和预测因素。

方法

根据血管造影，对 687 名（487 名男性）连续患者的共存 CAD、SAD、PAD 和 RAS（狭窄> =50%）的频率进行了确定，这些患者年龄为 63.5 +/- 9.1 岁，因疑似 CAD 而行冠状动脉造影。

结果

在 545 名（79.3%）患者中发现了显著的 CAD（1 支血管病变 164 例；2 支血管病变 157 例；3 支血管病变 224 例）。在 136 名（19.8%）、55 名（8%）和 103 名（15%）患者中分别发现了 SAD、RAS 和 PAD。在确诊 CAD 的 545 名患者中，346 名（63.5%）患者的狭窄仅局限于冠状动脉。2、3 和 4 级 PVA 分别在 130 名（23.8%）、61 名（11.2%）和 8 名（1.5%）患者中发现。在 142 名无 CAD 的患者中，127 名（89.4%）无其他明显狭窄，12 名（8.5%）有 1 个额外的冠状动脉病变，3 名（2.1%）有 2 个病变。向后逐步二元逻辑回归分析显示至少 2 级 PVA 的独立预测因素为：2 支和 3 支 CAD（p<0.001）、高脂血症（p=0.067）、吸烟（p<0.001）、肌酐水平> =1.3ml/dl（p<0.001）、下肢跛行（p<0.001）和女性（p=0.003）。跛行患者发生至少 2 个部位 PVA 的相对风险是无跛行患者的 15.7 倍，多支 CAD 患者的 2.1 倍，血清肌酐水平>1.3mg/dl 的患者的 2.8 倍；高脂血症、吸烟者和女性患者发生至少 2 个部位 PVA 的相对风险分别为 1.9 倍、2.4 倍和 2 倍。