Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College.
Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland.
Cardiol J. 2020;27(4):384-393. doi: 10.5603/CJ.a2018.0101. Epub 2018 Sep 20.
Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented.
271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD.
Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms.
Patients with AAA might benefit from an early coronary artery evaluation strategy.
腹主动脉瘤（AAA）和冠状动脉粥样硬化有共同的危险因素。本研究介绍了单一中心同时患有 AAA 和冠心病（CAD）患者的管理经验。
回顾了 271 例接受择期 AAA 修复的连续患者。118 例患者进行了冠状动脉成像，以探讨 AAA 与 CAD 共存的情况。
65.3%的患者存在明显的冠状动脉狭窄（>70%）。26.3%的患者有心脏血运重建史，31.4%有心肌梗死（MI）史，39.8%两者均有。亚组分析显示，既往经皮冠状动脉介入治疗（PCI）史（OR=6.9，95%CI 2.6-18.2，p<0.001）和患者年龄（OR=1.1，95%CI 1.0-1.2，p=0.007）是明显冠状动脉狭窄的独立预测因素。仅 52.0%（40/77）有明显冠状动脉狭窄的患者在 AAA 修复前进行了即刻冠状动脉血运重建：32 例患者行 PCI（4 例药物洗脱支架和 27 例金属裸支架），8 例患者行冠状动脉旁路移植术。手术前进行血运重建的患者，从冠状动脉成像到 AAA 修复的平均时间较长（123.6 比 58.1 天，p<0.001）。在 AAA 修复前进行冠状动脉评估的患者，中位住院时间（7[2-70]比 7[3-181]天，p=0.007）和重症监护病房入住时间（1[0-9]比 1[0-70]天，p=0.014）较短，且主要不良心血管事件或多器官衰竭的发生率也较低（0%比 3.9%，p=0.035）。共有 11.0%的患者有冠状动脉瘤。
AAA 患者可能受益于早期冠状动脉评估策略。
