Núñez-Gil Iván J, Terol Belén, Feltes Gisela, Nombela-Franco Luis, Salinas Pablo, Escaned Javier, Jiménez-Quevedo Pilar, Gonzalo Nieves, Vivas David, Bautista Daniel, Macaya Carlos, Fernández-Ortiz Antonio
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain..
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Cardiovasc Revasc Med. 2018 Jul-Aug;19(5 Pt B):589-596. doi: 10.1016/j.carrev.2017.12.003. Epub 2017 Dec 6.
Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms.
Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013. Among 51,555 consecutive coronary angiograms, 414 patients with aneurysms were reported, of which 256 were considered acute (82% NSTE-ACS).
Predominantly male (80%, mean age 65.5years), cardiovascular risk factors were common (hypertension 65%, dyslipidemia 65%, obesity 25%, diabetes mellitus 28.5%, and smokers 67%). With frequent coronary stenoses (94%), mostly with one aneurysm (80%), it was observed more frequently in the anterior descending artery. After a median follow-up of 52months, 53 died (14 cardiac causes) and 42% presented a cardiovascular event. Complications from the aneurysm were found in 4. The duration of dual antiplatelet therapy, LVEF, age and peripheral vascular disease highlighted in the multivariate analysis of death.
The presence of coronary aneurysms in patients undergoing coronary angiography with an acute event is low. Patients who present them also have a large burden of atherosclerotic risk factors. In the long-term, the probability of cardiovascular complications is high, but only a small proportion are due to the aneurysm itself. A more intense and prolonged antithrombotic treatment may result in lower mortality rates.
冠状动脉瘤（直径为参考血管的1.5倍）并不常见，随着冠状动脉造影技术的应用，其诊断频率不断增加。发病率在1.5%至5%之间。报道的并发症多种多样：血栓形成、远端栓塞、破裂和血管痉挛，可导致缺血、心力衰竭或心律失常。然而，其自然病程和预后仍不明确。我们旨在描述急性冠状动脉瘤患者的特征。
对2002年至2013年间诊断为冠状动脉瘤的患者进行前瞻性冠状动脉造影登记。在连续51555例冠状动脉造影中，报告了414例动脉瘤患者，其中256例被认为是急性的（82%为非ST段抬高型急性冠状动脉综合征）。
患者以男性为主（80%），平均年龄65.5岁，心血管危险因素常见（高血压65%、血脂异常65%、肥胖25%、糖尿病28.5%、吸烟者67%）。冠状动脉狭窄常见（94%），大多为单个动脉瘤（80%），在前降支更为常见。中位随访52个月后，53例死亡（14例因心脏原因），42%发生心血管事件。发现4例动脉瘤并发症。在死亡的多因素分析中，双联抗血小板治疗的持续时间、左心室射血分数、年龄和外周血管疾病具有显著意义。
在急性冠状动脉造影患者中，冠状动脉瘤的发生率较低。出现冠状动脉瘤的患者也有大量的动脉粥样硬化危险因素。从长期来看，心血管并发症的可能性较高，但只有一小部分是由动脉瘤本身引起的。更强化和延长的抗栓治疗可能会降低死亡率。
