Tayyebi Mohammad, Sani Mitra Danesh, Moghadam Hamid Reza Mashreghi, Gholoobi Arash, Morovatdar Negar, Ramezani Javad
Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mashhad University of Medical Sciences, Mashhad, Iran.
Open Access Maced J Med Sci. 2019 Jul 14;7(13):2108-2113. doi: 10.3889/oamjms.2019.608. eCollection 2019 Jul 15.
Many patients who are candidates for a pacemaker are also at the same time risk factors for coronary artery disease such as high blood pressure, hypertension, diabetes, and hyperlipidemia, and therefore the probability of having coronary artery disease is significant. Effective diagnostic measures can be taken to prove the factors affecting the incidence of CAD in patients undergoing pacemakers at high-risk, including angiography. Therefore, it can prevent complications during and after pacemaker implantation, which leads to an increase in the quality of treatment in patients requiring pacemaker implantation.
Therefore, the purpose of this study was to determine the predictive factors of significant coronary artery disease in patients with pacemaker implantation to identify patients in need of coronary angiography at the time of pacemaker implantation.
This retrospective study was carried out to examine the patients' files that were placed at the heart of Imam Reza Hospital during the period between March 2017 and September 2017. Demographic data, risk factors, echocardiography findings, and angiography, were collected and then recorded using a checklist. Statistical analysis was performed using SPSS software version 22 and Chi-square, and Mann-Whitney tests were used for determining significates variables.
A group of 102 patients who had undergone a permanent cardiac pacemaker insertion due to an atrioventricular (AV) Block were included in the study, and also coronary anatomy was determined coronary angiography. Based on the results, 13.7% of patients with cardiac pacemaker had obstructive coronary artery disease (stenosis > 70%). Factors affecting coronary artery stenosis on angiography include gender, chest pain, history of myocardial infarction, angioplasty, diabetes, smoking, history of aspirin intake, calcium blocker and Plavix, high hematocrit, ST elevation and ST depression in the ECG, and severe mitral regurgitation.
It seems that in most patients requiring permanent pacemaker insertion because of the atrioventricular (AV) Block, angiography does not change the patient's fate, and so can be ignored. However, in patients who have several risk factors from the listed above, coronary angiography is recommended during admission.
许多适合植入起搏器的患者同时也是冠状动脉疾病的危险因素，如高血压、高血脂、糖尿病和高脂血症患者，因此患冠状动脉疾病的可能性很大。可以采取有效的诊断措施来证明影响高危起搏器植入患者冠心病发病率的因素，包括血管造影。因此，它可以预防起搏器植入期间及之后的并发症，从而提高需要植入起搏器患者的治疗质量。
因此，本研究的目的是确定起搏器植入患者严重冠状动脉疾病的预测因素，以识别起搏器植入时需要进行冠状动脉造影的患者。
本回顾性研究通过查阅2017年3月至2017年9月期间位于伊玛目礼萨医院中心的患者档案进行。收集人口统计学数据、危险因素、超声心动图检查结果和血管造影数据，然后使用检查表进行记录。使用SPSS 22软件进行统计分析，采用卡方检验和曼-惠特尼检验来确定显著变量。
一组因房室传导阻滞而接受永久性心脏起搏器植入的102例患者被纳入研究，并通过冠状动脉造影确定冠状动脉解剖结构。结果显示，13.7%的心脏起搏器植入患者患有阻塞性冠状动脉疾病（狭窄>70%）。血管造影中影响冠状动脉狭窄的因素包括性别、胸痛、心肌梗死病史、血管成形术、糖尿病、吸烟、服用阿司匹林病史、钙通道阻滞剂和波立维、高血细胞比容、心电图ST段抬高和压低以及严重二尖瓣反流。
似乎在大多数因房室传导阻滞而需要植入永久性起搏器的患者中，血管造影不会改变患者的预后，因此可以忽略。然而，对于有上述几种危险因素的患者，建议在入院期间进行冠状动脉造影。
