Rangel A, Hernández J, Iris J M, Baduí E, Chávez E
Departamento de Hemodinamia, Hospital de Especialidades, Centro Médico La Raza, IMSS, México D.F.
Arch Inst Cardiol Mex. 1996 Jan-Feb;66(1):60-9.
Among 407 patients with rheumatic heart disease studied in our department, we found 8.3% with coronary atherosclerosis: 2.7% with mitral stenosis and 2.4% with aortic stenosis, lower figures than those reported in the literature. In our patients with coronary atherosclerosis, the male to female ratio was 1.6:1. The mean age of men and women with coronary atherosclerosis were 58.9 +/- 8.48 years and 60.33 +/- 5.75 years respectively. The cumulated relative frequency curve of the age was shifted to the right in the patients with coronary atherosclerosis, compared with the age frequency curve of the patients with normal coronary arteries: 50% of the cases with coronary atherosclerosis were < or = 60 years old; on the other hand, 50% of the patients with normal coronary arteries were < 53 years old. We only discovered 3 patients younger than 50 years old with coronary atherosclerosis. In order of frequency, the coronary arteries more affected were the anterior descending, right and circumflex. The mean coronary stenosis was 75.2 +/- 21.2%. Disease of one vessel was observed more frequently. We believe that age is not a good parameter to indicate coronarography in patients with valvular heart disease. If coronarography would be performed in all patients with valvular disease > or = 30 or 40 years old, would result in a great number of normal studies, with the consequent misspend of supplies and the increased risk of complications. On the other hand, restricting the coronarography indication, would miss the diagnosis in patients that might need myocardial revascularization. To restrict or to increase the indication of coronarography in patients with valvular disease will depend of the frequency between rheumatic heart disease and associated coronary atherosclerosis, and also on the atherosclerosis risk factors present in each patient. We recommend not to use the age of the patients as an index to indicate coronarography.
在我科研究的407例风湿性心脏病患者中，我们发现8.3%患有冠状动脉粥样硬化：二尖瓣狭窄患者占2.7%，主动脉瓣狭窄患者占2.4%，这些数字低于文献报道。在我们患有冠状动脉粥样硬化的患者中，男女比例为1.6:1。患有冠状动脉粥样硬化的男性和女性的平均年龄分别为58.9±8.48岁和60.33±5.75岁。与冠状动脉正常患者的年龄频率曲线相比，冠状动脉粥样硬化患者的年龄累积相对频率曲线向右偏移：50%的冠状动脉粥样硬化病例年龄≤60岁；另一方面，50%的冠状动脉正常患者年龄<53岁。我们仅发现3例年龄小于50岁的冠状动脉粥样硬化患者。按受累频率排序，受影响更严重的冠状动脉依次为前降支、右冠状动脉和回旋支。平均冠状动脉狭窄程度为75.2±21.2%。单支血管病变更为常见。我们认为，年龄不是瓣膜性心脏病患者进行冠状动脉造影的良好指标。如果对所有年龄≥30或40岁的瓣膜病患者都进行冠状动脉造影，将会有大量正常检查结果，从而导致物资浪费和并发症风险增加。另一方面，限制冠状动脉造影的指征，可能会漏诊那些可能需要心肌血运重建的患者。在瓣膜病患者中限制或增加冠状动脉造影的指征，将取决于风湿性心脏病与相关冠状动脉粥样硬化之间的频率，以及每位患者存在的动脉粥样硬化危险因素。我们建议不要将患者年龄作为冠状动脉造影的指征。
