Wang H, Fang F, Chai K, Li Y Y, Luo Y, Liu D G, Liu D P, Yang J F
Department of Cardiology, National Center of Gerontology, Beijing Hospital, Beijing 100730, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Jul 24;45(7):591-596. doi: 10.3760/cma.j.issn.0253-3758.2017.07.008.
To analyze the cardiac pathological features of elderly coronary artery disease (CAD) patients (60 years and over) and evaluate the pathological features at autopsy and risk factors of patients with acute myocardial infarction (AMI). Data from 471 elderly patients (aged from 60 to 100 years old) with CAD confirmed by autopsy hospitalized in our hospital from April 1969 to October 2013 were retrospectively reviewed. Patients were divided into 2 groups: AMI group(=128) with AMI as the primary cause of death and the rest served as control group(=343). The pathological features of coronary lesion and related risk factors of AMI were analyzed. In patients aged 60 and over with CAD, 48.8%(230/471) had severe coronary stenosis, 18.7%(88/471) had three-vessel disease, 71.8% cases (338/471) had left anterior descending artery(LAD)grade Ⅲ and over stenosis, 29.9% (141/471) had LAD grade Ⅳ stenosis, 25.9%(122/471) had left main coronary artery(LM) grade Ⅲ and over stenosis, 9.6%(45/471) had LM grade Ⅳ stenosis, 27.1%(128/471) had AMI. The first AMI accounts for 39.1%(50/128), and 60.9%(78/128) had both AMI and old MI. Compared with the control group, AMI group were younger ((77.1±11.6) years vs. (83.2±9.1) years, <0.01), had more severe coronary artery stenosis lesion (77.3%(99/128) vs. 38.2%(131/343), <0.01), higher coronary index which reflects the overall arteriosclerosis (9.9±2.8 vs. 8.0±2.5, <0.01), more three-vessel disease (30.3%(43/128) vs. 13.7%(45/343), <0.01), heavier heart weight ((447.8±90.6)g vs. (426.6±99.1)g, <0.05), higher prevlence of pulmonary congestion or edema (57.8%(74/128) vs. 39.9%(137/343), <0.01). Twenty-three cardiac ruptures (23/128, 18.0%) were observed in AMI group. Logistic regression analysis showed that grade Ⅳ LAD stenosis (=3.55, 95% 2.05-6.17, <0.01), three-vessel disease(=2.47, 95% 1.30-4.67, <0.01) were the independent risk factors of AMI in elderly patients with CAD. Severe coronary stenosis is common in CAD patients aged 60 and over. Patients aged 60 and over with AMI have more severe coronary artery stenosis lesion and heavier heart weight. Cardiac rupture is not uncommon in elderly patients with AMI. Severe LAD stenosis and three-vessel disease are the independent risk factors of AMI in the elderly.
分析老年冠状动脉疾病（CAD）患者（60岁及以上）的心脏病理特征，并评估急性心肌梗死（AMI）患者的尸检病理特征及危险因素。回顾性分析1969年4月至2013年10月在我院住院的471例经尸检确诊的老年CAD患者（年龄60至100岁）的数据。患者分为2组：以AMI为主要死亡原因的AMI组（n = 128），其余为对照组（n = 343）。分析冠状动脉病变的病理特征及AMI的相关危险因素。在60岁及以上的CAD患者中，48.8%（230/471）有严重冠状动脉狭窄，18.7%（88/471）有三支血管病变，71.8%（338/471）病例左前降支（LAD）Ⅲ级及以上狭窄，29.9%（141/471）有LADⅣ级狭窄，25.9%（122/471）有左主干（LM）Ⅲ级及以上狭窄，9.6%（45/471）有LMⅣ级狭窄，27.1%（128/471）有AMI。首次AMI占39.1%（50/128），60.9%（78/128）既有AMI又有陈旧性心肌梗死。与对照组相比，AMI组年龄更小（（77.1±11.6）岁 vs.（83.2±9.1）岁，P<0.01），冠状动脉狭窄病变更严重（77.3%（99/128） vs. 38.2%（131/343），P<0.01），反映总体动脉硬化的冠状动脉指数更高（9.9±2.8 vs. 8.0±2.5，P<0.01），三支血管病变更多（30.3%（43/128） vs. 13.7%（45/343），P<0.01），心脏重量更重（（447.8±90.6）g vs.（426.6±99.1）g ,P<0.05），肺淤血或肺水肿发生率更高（57.8%（74/128） vs. 39.9%（137/343），P<0.01）。在AMI组观察到23例心脏破裂（23/128，18.0%）。Logistic回归分析显示，LADⅣ级狭窄（β = 3.55，95%CI 2.05 - 6.17，P<0.01）、三支血管病变（β = 2.47，95%CI 1.30 - 4.67，P<0.01）是老年CAD患者发生AMI的独立危险因素。严重冠状动脉狭窄在60岁及以上的CAD患者中常见。60岁及以上的AMI患者冠状动脉狭窄病变更严重，心脏重量更重。心脏破裂在老年AMI患者中并不少见。严重LAD狭窄和三支血管病变是老年患者发生AMI的独立危险因素。
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