冠状动脉瘤92例冠脉造影和临床特点分析

Analysis on coronary angiography and clinical charactoristics of 92 patients with coronary artery aneurysm

目的探讨成人冠状动脉瘤(CAA)的冠状动脉造影特征和心电图的变化。方法回顾性分析92例成人冠状动脉瘤冠脉造影、临床表现及心电图的特点。结果成人冠状动脉瘤的冠状动脉造影检出率为1.43%(92/6452)。全部病例均有临床症状,有心绞痛病史63例(68.5%),合并心肌梗死21例(22.8%);单纯CAA患者20例(21.7%),同时伴有冠状动脉狭窄≥50%者72例(78.3%);瘤体内发现血栓51例(55.4%)。瘤体发生于单支冠状动脉61例(66.3%),多发生于血管远段。右冠状动脉(57/121,47.1%)是最易发生瘤体的血管。伴有心电图ST-T改变67例(72.8%),运动试验检查55例,阳性38例,可疑阳性5例。单纯冠状动脉瘤患者和伴有冠状动脉狭窄≥50%者临床表现和心电图变化的差异无统计学意义(P>0.05)。结论成人冠状动脉瘤无论是否伴有冠状动脉狭窄,均可能引起心肌缺血,甚至导致心肌梗死。

Objective To explore the coronary angiographic characteristics and electrocardiographic changes of adult coronary artery aneurysm（CAA） .Methods The clinical manifestation and electrocardiographic changes of adult CAA in 92 patients with coronary angiography were retrospectively analyzed. Results The prevalence rate of adult CAA detection was 1.42% （92/6 452）. All cases had clinical symptoms, and 63（68.5% ）of them had angina attack history, 21（22.8% ） of them had myocardial infarction.20（21.7% ） cases were diagnosed simply CAA, while 72 （78.3%） of them associated to coronary artery stenotic lesions ≥ 50%. Thrombus were found in aneurysm of 51 patients（55.4% ）. Angiographic fmdings showed 61 （66.3%）patients with CAA involved only one coronary artery branch, most of them prevalence to distal part of vessels. Right coronary artery was the most frequent ectatic vessel （57/121,47.1%）.In addition, 67 cases（72.8%） had electrocardiographic changes of SY-T.55 cases underwent exercise test,and 38 of them were positive,5 of them were suspec ted positive. There were no significant difference in clinical symptoms and the electrocardiographic features between simply CAA cases and CAA associated with coronary artery stenotic lesions ≥50% （ P 〉 0.05）.Conclusion In adult CAA,the myocardial ischemia could be occurred whether it associated with coronary stenosis, even for myocardial infarction.