Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Rheumatology and Clinical Immunology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Currently: Department of Rheumatology, 2nd Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
Can J Cardiol. 2021 Jun;37(6):895-903. doi: 10.1016/j.cjca.2020.11.011. Epub 2020 Dec 11.
Coronary artery involvement is a severe but uncommon manifestation of polyarteritis nodosa (PAN), so clinicians have little knowledge of it. Our aim was to investigate the clinical characteristics, risk factors and outcomes of patients with PAN complicated with coronary artery lesions.
Data from 145 patients with PAN who were admitted to Peking Union Medical College Hospital from January 2000 to September 2019 were retrospectively collected.
Nineteen patients (13.1%) had coronary artery lesions due to PAN. The age at the onset of PAN was 32.3 ± 11.8 years. There were no significant differences in common risk factors for coronary arterial atherosclerosis between the patients with coronary artery involvement and those without. Affected branches of the coronary arteries were left anterior descending branch (15 patients), right coronary artery (14 patients), and left circumflex branch (9 patients). Eleven of the 19 patients exhibited multivessel lesions. Multivariate logistic regression analysis showed that celiac artery involvement (odds ratio [OR] 3.722, 95% confidence interval [CI] 1.115-12.427; P = 0.033) and new-onset hypertension (OR 6.668, 95% CI 1.936-22.961; P = 0.003) were risk factors for coronary artery involvement in patients with PAN. Stent placement was performed for 2 patients, and in-stent restenosis occurred in 1 of those patients a year later.
PAN with coronary artery involvement exhibits more combined involvement of arteries of other organs and more severe diseases. PAN should be considered when treating young adults with an unknown origin of coronary artery lesions. In addition to systemic immunosuppressive treatment, other measures including antiplatelet and anticoagulation therapy should be initiated; however, determining the optimal time to perform procedures such as intervention or surgery is still challenging.
冠状动脉受累是结节性多动脉炎（PAN）的一种严重但罕见的表现，因此临床医生对此了解甚少。我们旨在探讨合并冠状动脉病变的 PAN 患者的临床特征、危险因素和结局。
回顾性收集了 2000 年 1 月至 2019 年 9 月期间北京协和医院收治的 145 例 PAN 患者的数据。
19 例（13.1%）患者因 PAN 合并冠状动脉病变。PAN 的发病年龄为 32.3±11.8 岁。合并冠状动脉受累与无冠状动脉受累的 PAN 患者的冠状动脉粥样硬化常见危险因素无显著差异。受累的冠状动脉分支包括左前降支（15 例）、右冠状动脉（14 例）和左回旋支（9 例）。19 例患者中有 11 例为多支血管病变。多变量 logistic 回归分析显示，腹腔动脉受累（比值比[OR] 3.722，95%置信区间[CI] 1.115-12.427；P=0.033）和新发高血压（OR 6.668，95% CI 1.936-22.961；P=0.003）是 PAN 患者发生冠状动脉受累的危险因素。2 例患者进行了支架置入术，其中 1 例患者在 1 年后出现支架内再狭窄。
合并冠状动脉受累的 PAN 表现为更多的其他器官动脉联合受累和更严重的疾病。对于冠状动脉病变病因不明的年轻成年患者，应考虑到 PAN。除了全身免疫抑制治疗外，还应启动其他措施，包括抗血小板和抗凝治疗；然而，确定进行介入或手术等治疗的最佳时机仍然具有挑战性。
