Center for Pulmonary Vascular Disease, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
Am J Cardiol. 2011 Aug 1;108(3):460-4. doi: 10.1016/j.amjcard.2011.03.066. Epub 2011 May 19.
The occurrence and impact of coronary artery disease (CAD) among patients with pulmonary arterial hypertension (PAH) are unknown. We aimed to determine the prevalence, clinical correlates, and effect of CAD in patients with PAH. We reviewed the medical records of consecutive patients diagnosed with PAH at a university-based referral center for pulmonary vascular disease from January 1990 to May 2010. The patients systematically underwent right heart catheterization and coronary angiography as a part of their evaluation. The patients with PAH with CAD (defined as ≥50% stenosis in ≥1 major epicardial coronary artery) were compared to patients without CAD. Among the 162 patients with PAH, the prevalence of CAD was 28.4%. The presence of CAD was associated with older age (66.6 ± 11.5 vs 49.2 ± 14.0 years, p <0.001), systemic hypertension, and dyslipidemia. The patients with PAH and CAD had a lower mean pulmonary arterial pressure (44.6 ± 11.1 vs 49.2 ± 14.0 mm Hg; p = 0.02) than patients without CAD. During a median follow-up of 36 months, 73 patients died. The presence of CAD was a predictor of all-cause mortality on univariate analysis (hazard ratio 1.97, 95% confidence interval 1.21 to 3.20) but not on multivariate analysis, which identified older age (hazard ratio 1.03, 95% confidence interval 1.01 to 1.05) and right atrial pressure (hazard ratio 1.08, 95% confidence interval 1.03 to 1.14) as the only independent predictors. In conclusion, our study has demonstrated that CAD is common among patients with PAH. CAD prevalence increases with age, dyslipidemia, and hypertension, but we did not detect an independent prognostic effect of CAD on mortality.
在肺动脉高压（PAH）患者中，冠状动脉疾病（CAD）的发生和影响尚不清楚。我们旨在确定 PAH 患者中 CAD 的患病率、临床相关性和影响。我们回顾了 1990 年 1 月至 2010 年 5 月在一家大学附属医院的肺血管疾病转诊中心诊断为 PAH 的连续患者的病历。这些患者系统地接受了右心导管检查和冠状动脉造影，作为其评估的一部分。将有 CAD（定义为≥1 个主要心外膜冠状动脉≥50%狭窄）的 PAH 患者与无 CAD 的患者进行比较。在 162 例 PAH 患者中，CAD 的患病率为 28.4%。CAD 的存在与年龄较大（66.6±11.5 岁比 49.2±14.0 岁，p<0.001）、高血压和血脂异常有关。CAD 患者的平均肺动脉压（44.6±11.1 毫米汞柱比 49.2±14.0 毫米汞柱；p=0.02）低于无 CAD 的患者。在中位数为 36 个月的随访期间，73 例患者死亡。CAD 的存在是单因素分析中全因死亡率的预测因素（危险比 1.97，95%置信区间 1.21 至 3.20），但不是多因素分析中的预测因素，多因素分析确定了年龄较大（危险比 1.03，95%置信区间 1.01 至 1.05）和右心房压（危险比 1.08，95%置信区间 1.03 至 1.14）是唯一的独立预测因素。总之，我们的研究表明，CAD 在 PAH 患者中很常见。CAD 的患病率随年龄、血脂异常和高血压而增加，但我们没有检测到 CAD 对死亡率的独立预后影响。
