CAJ | 학술논문

目的探讨高龄Stanford B型主动脉夹层(aortic dissection,AD)患者中冠心病(coronary artery disease,CAD)的发病情况及其对预后的影响.方法连续人选2008年1月至2011年12月,200例50岁以上Stanford B型AD患者行胸主动脉腔内修复治疗(thoracic aortic repair,TEVAR),主动脉造影及腔内修复术前常规行冠状动脉造影(coronary angiography,CAG)判断冠状动脉病变程度.所有患者随访1年,比较AD患者中有CAD与无CAD患者不良事件发生率.结果 CAG提示,200例AD患者中53例(26.5％)有CAD.多元回归分析发现,男性(OR=4.415,95％ CI:1.131～ 17.237,P=0.033)和年龄(OR=1.061,95％ CI:1.017～1.108,P=0.006)是共患CAD的独立预测因素,年龄是多支病变/左主干病变的独立预测因素(OR=1.096,95％ CI:1.009～1.191,P=0.023).并发CAD患者与非CAD患者不良事件发生率差异无统计学意义,CAD患者与非CAD患者相比,1年心肌梗死[3例(5.66％)对0例(0),P=0.018]和卒中[4例(7.55％)对1例(0.68％),P=0.018]发生率显著高.结论高龄Stanford B型主动脉夹层患者并发CAD比例较高,并发CAD患者心脑血管缺血事件风险高于非CAD患者,但并未增加主动脉相关不良事件风险.
목적 탐토고령Stanford B형주동맥협층(aortic dissection,AD)환자중관심병(coronary artery disease,CAD)적발병정황급기대예후적영향.방법 련속인선2008년1월지2011년12월,200례50세이상Stanford B형AD환자행흉주동맥강내수복치료(thoracic aortic repair,TEVAR),주동맥조영급강내수복술전상규행관상동맥조영(coronary angiography,CAG)판단관상동맥병변정도.소유환자수방1년,비교AD환자중유CAD여무CAD환자불량사건발생솔.결과 CAG제시,200례AD환자중53례(26.5％)유CAD.다원회귀분석발현,남성(OR=4.415,95％ CI:1.131～ 17.237,P=0.033)화년령(OR=1.061,95％ CI:1.017～1.108,P=0.006)시공환CAD적독립예측인소,년령시다지병변/좌주간병변적독립예측인소(OR=1.096,95％ CI:1.009～1.191,P=0.023).병발CAD환자여비CAD환자불량사건발생솔차이무통계학의의,CAD환자여비CAD환자상비,1년심기경사[3례(5.66％)대0례(0),P=0.018]화졸중[4례(7.55％)대1례(0.68％),P=0.018]발생솔현저고.결론 고령Stanford B형주동맥협층환자병발CAD비례교고,병발CAD환자심뇌혈관결혈사건풍험고우비CAD환자,단병미증가주동맥상관불량사건풍험.
Objective To evaluate the prevalence and impact of coronary artery disease (CAD) in aged patients with Stanford type B aortic dissection(AD).Methods From January 2008 to December 2011,CAG was routinely performed before aortography and thoracic aortic repair(TEVAR) to determine the prevalence of concomitant CAD in 200 consecutive Stanford type B AD patients who were older than 50 years.All patients received 1 year follow-up.Adverse events were compared between patients with and without concomitant CAD.Data analysis by SPSS 17.0 statistical software,using Student t test,Chi-square test and Fisher exact test.Results CAG showed 53 patients (26.5％) had CAD.Multivariate logistic regression analysis showed that male gender(OR =4.415,95％ CI:1.131-17.237,P =0.033) and age (OR =1.061,95％ CI:1.017-1.108,P =0.006) were independent predictors of Stanford type BAD coexisted with CAD.Age was also independent predictor of multi-vessel disease(MVD) and/or left main disease(LMD) (OR =1.096,95％ CI:1.009-1.191,P =0.023).At 30-day follow-up,there was no difference in the incidence of adverse events between patients with and without concomitant CAD.Patients with concomitant CAD showed higher incidence of myocardial infarction[3 (5.66％) vs.0(0),P =0.018] and stroke [4 (7.55 ％) vs.1 (0.68 ％),P =0.018].Conclusion The prevalence of CAD in aged patients with Stanford type BAD is relatively high.Concomitant CAD is associated with higher risk of cardio-cerebrovascular ischemic events while dose not increase the risk of adverse aorta related events.