绝经前女性冠心病患者的临床和冠状动脉造影特点

Clinical and Angiographic Characteristics of Pre-Menopausal Women With Coronary Atery Disease

目的:分析绝经前女性冠心病(CAD)患者的临床和冠状动脉(冠脉)造影特点。方法:对比2004-04至2007-12所有第一次因胸部不适而行冠脉造影的绝经前565例患者,根据造影结果分为绝经前冠心病组280例,平均年龄(44.12±4.48)岁,绝经前正常组285例,平均年龄(44.24±3.48)岁,绝经后经冠脉造影确定冠心病的患者为绝经后冠心病组721例,平均年龄(58.09±1.44)岁,分析其临床和冠脉造影特点。结果:绝经前冠心病组与绝经后冠心病组相比,高血压(55%比66%)、2型糖尿病(15.0%比31.5%)和高脂血症(23.9%比37.4%)的发生率显著减少,P均<0.05。绝经前冠心病组比绝经后冠心病组单支病变的发生率显著增高(43.2%比26.9%,P<0.001),差异有统计学意义;而三支病变的发生率则显著降低(20.4%比33.8%,P<0.001);左主干(2.9%比1.1%,P=0.048)和前降支近端(50.4%比38.6%,P<0.001)重度狭窄(狭窄≥90%)的发生率却显著增高,差异有统计学意义。结论:绝经前女性具有典型胸痛症状,冠脉造影常显示严重的冠脉狭窄病变,而且这些病变常位于左主干和前降支近端。

Objective： To analyze the clinical and angiographic characteristics of pre-menopausal women with coronary artery disease （CAD）. Methods ： A total of 565 female patints at per-menopausal condition from April 2004 to December 2007 in our hospital who undertaken coronary angiography for the new onset of chest discomfort were studied. According to the result of coronary angiography （presence,localization, length and severity of the lesion）, the patients were divided into Pre-menopausal CAD group, n = 280, with the mean age of（44. 12±4.48）years and Non pre-menopausal CAD（ Non CAD）group, n = 285,with the mean age of （44. 24±3.48）years;in addition, there were 721 female patients were enrolled as Post-menopausal CAD group by the result of coronary angiography at the mean age of（ 58. 09 ± 1.44 ） years. The clinical data and angiographic characteristics were studied between Pre-menopausal CAD group and Post-menopansal CAD group. Results： Pre-menopausal CAD guoup presented less frequently with hypertension, diabetes mellitus and dyslipidemia compared with Post-menopausal CAD group （55% vs 66%, 15 % vs 31.5 % and 23.9% vs 37.4%, P 〈 0. 05 respectively ）. We found more frequent involvement of single vessel lesion in Pre-menopausal CAD group than in Post-menopausal CAD group （43.2% vs 26.9% P 〈0. 001 ）, more triple vessls lesion in Post-menopausal CAD group（ 33.8% vs 20.4% P 〈 0. 001 ）, and much more severe lesion（≥90% ） at left main（2. 9% vs 1.1%, P = 0. 048）and proximal left anterior descending（LAD） artery （28.2% vs 16. 6% ,P 〈0. 001 ）in Pre-menopausal CAD group compared with Post-menopausal CAD group. Conclusion：Pre-menopausal women with chest discomfort most likely presented atherosclerosis by angiography,it usually located at left main and proximal LA.D artery,which was the strong predictor of adverse clinical outcome.