Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Heart Vessels. 2021 Mar;36(3):308-314. doi: 10.1007/s00380-020-01700-2. Epub 2020 Sep 14.
Aortic aneurysm is an increasingly important public health problem with high morbidity and mortality. It is associated with coronary artery disease (CAD), which is a comorbidity of high incidence that is reported to worsen perioperative complications and long-term clinical outcomes in patients with an aortic aneurysm. Patients with significant coronary artery stenosis may require coronary revascularization and/or optimal medical therapy in the perioperative period of aneurysm surgery. However, the prognostic impact of non-significant coronary artery stenosis not indicated for coronary revascularization on clinical outcomes of patients with aortic aneurysms remains unclear. We performed coronary angiography on 239 consecutive patients with thoracic and abdominal aortic aneurysms before endovascular aortic repair or surgical repair. The patients were divided into the following 3 groups according to the severity of stenosis of major coronary arteries: non-CAD group (with < 25% stenosis), non-significant CAD group (with ≥ 25% but < 75% stenosis), and significant CAD group (with ≥ 75% stenosis). CAD was diagnosed in 133 (56%) patients consisting of 48 (20%) patients with non-significant CAD and 85 (36%) patients with significant CAD. Thirty-nine major adverse cardiovascular and cerebrovascular events (MACCEs) occurred in a median follow-up period of 723 days. Kaplan-Meier analysis revealed that the risk of MACCEs was higher in the significant and non-significant CAD groups than in the non-CAD group. Multivariate Cox proportional hazard regression analysis showed that the risk of MACCEs was equally high in the non-significant CAD and significant CAD groups compared to that in the non-CAD group after adjustment for confounding factors. CAD is significantly associated with poor outcomes in patients with aortic aneurysms, irrespective of the significance of CAD.
主动脉瘤是一个日益重要的公共卫生问题，具有高发病率和死亡率。它与冠状动脉疾病（CAD）有关，CAD 是一种发病率较高的合并症，据报道会增加主动脉瘤患者围手术期并发症和长期临床结局的恶化风险。有明显冠状动脉狭窄的患者可能需要在动脉瘤手术的围手术期进行冠状动脉血运重建和/或最佳药物治疗。然而，对于未经冠状动脉血运重建指征的非显著冠状动脉狭窄对主动脉瘤患者临床结局的预后影响尚不清楚。我们对 239 例接受胸腹部主动脉瘤血管内修复或手术修复的连续患者进行了冠状动脉造影。根据主要冠状动脉狭窄的严重程度，患者分为以下 3 组：非 CAD 组（狭窄<25%）、非显著 CAD 组（狭窄≥25%但<75%）和显著 CAD 组（狭窄≥75%）。诊断为 CAD 的患者有 133 例（56%），其中 48 例（20%）为非显著 CAD，85 例（36%）为显著 CAD。在中位随访 723 天期间，发生了 39 例主要不良心血管和脑血管事件（MACCEs）。Kaplan-Meier 分析显示，在显著 CAD 和非显著 CAD 组中，MACCE 的风险高于非 CAD 组。多变量 Cox 比例风险回归分析显示，在校正混杂因素后，非显著 CAD 和显著 CAD 组与非 CAD 组相比，MACCE 的风险同样较高。CAD 与主动脉瘤患者的不良结局显著相关，而不论 CAD 的严重程度如何。
