诊断为冠状动脉疾病患者的主动脉外颅动脉粥样硬化病变：患病率和预测因素。

Supra-aortic extracranial artery atherosclerotic lesions in patients diagnosed for coronary artery disease: prevalence and predictors.

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):985-91.

PMID:19784903

Abstract

BACKGROUND

In patients with coronary artery disease (CAD), the presence of atherosclerotic lesions in other vascular beds is associated with a markedly worse prognosis.

AIM

To determine the prevalence and predictors of extracranial supra-aortic artery atherosclerotic disease (SAD) in patients with suspected CAD.

METHODS

Supra-aortic artery angiography was performed in 379 consecutive patients aged 64.2 +/- 8.8 years (231 male) referred for coronary angiography. Clinical and laboratory data (total cholesterol, LDL, HDL cholesterol, hs-CRP, creatinine level) and left ventricular ejection fraction were analysed.

RESULTS

Significant stenosis (> or =50% by quantitative angiography) within at least one main branch of the coronary arteries was found in 314 (82.8%) patients, including 87 (27.7%), 96 (30.6%) and 131 (41.7%) with 1-vessel, 2-vessel, and 3-vessel CAD, respectively. Among all 379 patients, stenosis > or =50% of the carotid artery was documented in 9.5%, vertebral in 13.7%, and subclavian in 7.4% of patients. We found 130 stenoses > or =50% within the supra-aortic arteries in 90 patients (23.7% of the whole study group, and 28.7% of CAD patients), including 42 internal carotid artery stenoses in 36 patients, 58 vertebral artery stenoses in 52, and 30 subclavian stenoses in 28 patients. In 24 (6.3%) patients more than one SAD was present. The SAD > or =50% was found in 8 (12.3%) patients without significant CAD, in 22 (25.3%), 17 (17.7%) and 43 (32.8%) with 1-, 2- and 3-vessel CAD, respectively (p = 0.001). Independent predictors of SAD > or =50% identified by multivariate analysis were: previous neurological ischaemic event (p = 0.001), CAD (p = 0.015), creatinine level (p = 0.031), male gender (p = 0.001), claudication (p < 0.001) and low HDL cholesterol (p = 0.033). The following independent predictors of vertebral and/or subclavian artery stenosis > 50% were identified: CAD severity (p = 0.002), creatinine level (p = 0.024), male gender (p = 0.013), claudication (p < 0.001) and low HDL cholesterol level (p = 0.059).

CONCLUSIONS

In a large patient sample, we have found that significant supra-aortic atherosclerosis is present in a quater of patients with suspected CAD. Importantly, SAD prevalence increases with CAD severity. Previous neurological ischaemic event, CAD, creatinine level, male gender, claudication and hyperlipidaemia were identified as independent predictors of SAD > or =50%.

摘要

背景

在患有冠状动脉疾病 (CAD) 的患者中，其他血管床的动脉粥样硬化病变与预后明显恶化相关。

目的

确定疑似 CAD 患者颅外主动脉以上动脉粥样硬化疾病 (SAD) 的患病率和预测因素。

方法

对 379 例年龄为 64.2 ± 8.8 岁（231 名男性）的连续患者进行了主动脉以上动脉造影，这些患者因冠状动脉造影而转介。分析了临床和实验室数据（总胆固醇、LDL、HDL 胆固醇、hs-CRP、肌酐水平）和左心室射血分数。

结果

在 314 例（82.8%）患者中发现至少一条主要冠状动脉分支存在明显狭窄（> 50%），其中 87 例（27.7%）、96 例（30.6%）和 131 例（41.7%）分别患有单支、双支和三支 CAD。在所有 379 例患者中，9.5%的患者颈动脉狭窄> 50%，13.7%的患者椎动脉狭窄> 50%，7.4%的患者锁骨下动脉狭窄> 50%。我们发现 90 例患者（整个研究组的 23.7%，CAD 患者的 28.7%）中有 130 处狭窄> 50%，其中 36 例患者有 42 处颈内动脉狭窄，52 例患者有 58 处椎动脉狭窄，28 例患者有 30 处锁骨下动脉狭窄。在 24 例（6.3%）患者中发现了超过一处 SAD。在 8 例（12.3%）无明显 CAD 的患者中发现了 SAD > 50%，在 22 例（25.3%）、17 例（17.7%）和 43 例（32.8%）有 1 支、2 支和 3 支 CAD 的患者中发现了 SAD > 50%（p = 0.001）。多变量分析确定的 SAD > 50%的独立预测因素为：既往神经缺血事件（p = 0.001）、CAD（p = 0.015）、肌酐水平（p = 0.031）、男性（p = 0.001）、跛行（p < 0.001）和低 HDL 胆固醇（p = 0.033）。确定椎动脉和/或锁骨下动脉狭窄> 50%的独立预测因素为：CAD 严重程度（p = 0.002）、肌酐水平（p = 0.024）、男性（p = 0.013）、跛行（p < 0.001）和低 HDL 胆固醇水平（p = 0.059）。