Nakayama Atsuko, Morita Hiroyuki, Hamamatsu Akihiko, Miyata Tetsuro, Hoshina Katsuyuki, Nagayama Masatoshi, Takanashi Shuichiro, Sumiyoshi Tetsuya, Komuro Issei
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Heart Vessels. 2015 May;30(3):304-8. doi: 10.1007/s00380-014-0488-5. Epub 2014 Mar 7.
In this study, the coronary findings in 185 autopsy cases with a ruptured abdominal aortic aneurysm (AAA) from the Tokyo Medical Examiner's Office were examined and compared with those in 1,056 patients undergoing AAA repair at the University of Tokyo Hospital or Sakakibara Heart Institute (Tokyo, Japan). The number of cases with any significant coronary stenosis was significantly greater in the autopsy cases with a ruptured AAA than in the patients undergoing emergency repair of a ruptured AAA, suggesting that the low prevalence of CAD observed in patients undergoing emergency repair of a ruptured AAA was due to the survival bias before reaching hospital. In addition, we also found that significant coronary left main trunk stenosis was more frequent in CAD cases with a ruptured AAA than in those with an unruptured AAA, findings that suggest novel clinical implications. Large-scale prospective studies are warranted to confirm our findings and to clarify the pathophysiological relationship between coronary atherosclerosis and AAA status.
在本研究中，对东京法医办公室185例腹主动脉瘤（AAA）破裂尸检病例的冠状动脉检查结果进行了分析，并与东京大学医院或日本东京榊原心脏研究所1056例接受AAA修复手术的患者进行了比较。AAA破裂尸检病例中存在任何显著冠状动脉狭窄的病例数显著多于接受AAA破裂急诊修复的患者，这表明在接受AAA破裂急诊修复的患者中观察到的冠心病低患病率是由于入院前的生存偏差所致。此外，我们还发现，AAA破裂的冠心病病例中显著的冠状动脉左主干狭窄比AAA未破裂的病例更常见，这些发现提示了新的临床意义。有必要进行大规模前瞻性研究以证实我们的发现，并阐明冠状动脉粥样硬化与AAA状态之间的病理生理关系。
