Alai Mohammad S, Beig Jahangir Rashid, Kumar Sanjay, Yaqoob Irfan, Hafeez Imran, Lone Ajaz A, Dar Mohammad Iqbal, Rather Hilal A
Department of Cardiology, SKIMS, Srinagar, India.
Department of Medicine, SKIMS, Srinagar, India.
Indian Heart J. 2016 Dec;68 Suppl 3(Suppl 3):S21-S25. doi: 10.1016/j.ihj.2016.06.013. Epub 2016 Jun 29.
This study was conducted to assess the prevalence and characterization of CAD in high risk patients requiring pacemaker implantation for symptomatic bradyarrhythmias.
This study included 100 patients with symptomatic sinus node dysfunction or atrioventricular block, who were at high risk of CAD or had previously documented atherosclerotic vascular disease (ASCVD). Coronary angiography was performed before pacemaker implantation. CAD was defined as the presence of any degree of narrowing in at least one major coronary artery or its first order branch. Obstructive CAD was defined as ≥50% diameter stenosis. CAD was categorized as single vessel disease (SVD), double vessel disease (DVD), or triple vessel disease (TVD); and obstructive CAD in the arteries supplying the conduction system was sub-classified according to Mosseri's classification.
Out of 100 patients (mean age 64.6±10.7 years), 45 (45%) had CAD. 29% patients had obstructive CAD while 16% had non-obstructive CAD. 53.3% patients had SVD, 15.6% had DVD and 31.1% had TVD. Among patients with obstructive CAD; Type I, II, III and IV coronary anatomies were present in 6.9%, 34.5%, 10.3% and 48.3% patients respectively. Presence of CAD significantly correlated with dyslipidemia (p=0.047), history of smoking (p=0.025), and family history of CAD (p=0.002).
Angiographic CAD is observed in a substantial proportion of patients with symptomatic bradyarrhythmias and risk factors for CAD. It could be argued that such patients should undergo a coronary work-up before pacemaker implantation. Treatment of concomitant CAD is likely to improve the long term prognosis of these patients.
本研究旨在评估因症状性缓慢性心律失常而需要植入起搏器的高危患者中冠心病（CAD）的患病率及特征。
本研究纳入了100例有症状性窦房结功能障碍或房室传导阻滞的患者，这些患者有患CAD的高风险或既往有动脉粥样硬化性血管疾病（ASCVD）记录。在植入起搏器前进行冠状动脉造影。CAD定义为至少一条主要冠状动脉或其一级分支存在任何程度的狭窄。阻塞性CAD定义为直径狭窄≥50%。CAD分为单支血管病变（SVD）、双支血管病变（DVD）或三支血管病变（TVD）；供应传导系统的动脉中的阻塞性CAD根据莫塞里分类法进行亚分类。
100例患者（平均年龄64.6±10.7岁）中，45例（45%）患有CAD。29%的患者患有阻塞性CAD，16%的患者患有非阻塞性CAD。53.3%的患者患有SVD，15.6%的患者患有DVD，31.1%的患者患有TVD。在阻塞性CAD患者中，I型、II型、III型和IV型冠状动脉解剖结构分别见于6.9%、34.5%、10.3%和48.3%的患者。CAD的存在与血脂异常（p = 0.047）、吸烟史（p = 0.025）和CAD家族史（p = 0.002）显著相关。
在有症状性缓慢性心律失常且有CAD危险因素的患者中，相当一部分患者存在造影显示的CAD。可以认为，此类患者在植入起搏器前应进行冠状动脉检查。同时治疗CAD可能会改善这些患者的长期预后。
