老年冠心病患者检查策略选择

A choice on testing strategy for elderly patients with coronary heart disease

目的探讨老年冠心病患者的检查策略。方法回顾2006—01—01～2008—06—31因冠状动脉粥样硬化性心脏病（CHD）住院治疗的老年患者资料。比较同次住院冠状动脉CT造影（CTA）和冠状动脉造影（CAG）对诊断冠状动脉病变的差异，并了解CTA和CAG后造影剂肾病（CIN）的发生情况。结果76例患者符合标准，男性56例，平均年龄（73．34±6．13）岁。两项检查问隔时间（10．79±7．57）d，累计造影剂用量（263．61±78．39）ml。共比较1140个冠状动脉节段，711个节段判断一致，占62．37％；161个节段差异〉30％，占11．40％；53个节段因血管细小、严重钙化及伪影干扰CTA不能判断，占6．49％。以CAG结果为标准，CTA诊断狭窄≥50％的冠状动脉病变的敏感性和特异性分别为90．76％和84．97％。CTA检查后1例发生CIN，占1．32％，CAG检查后有5例发生CIN，占6．58％。结论对疑似CHI）发作的高危老年患者应直接行CAG检查。

Objective To discuss the testing strategy for elderly patients with coronary artery disease. Methods The data of patients＇ record who admitted at the hospital for the episode of coronary heart disease （CHD） between January 1, 2006 and June 31, 2008 was retrospectively reviewed with following criteria： 60 years old and above; taking coronary CT angiography （CTA） and coronary angiography （CAG） in one admission. Results 76 patients met the criteria of which 56 were male. The mean age was 73.34±6.13 year-old ranging from 61 to 87. The mean interval time between CTA and CAG was 10.79± 7.57 days. The accumulative mean dose of contrast using in one patient was 263.61±78.39 mh A total of 1140 coronary artery segments were compared between CTA and CAG of which 711 segments, 62.37%, were similar, and 161 segments reflected discrepancy, greater than 30% （11.40%）, and 53 segments, 6.49%, cannot be assessed by radiologist according CTA imaging caused by small artery diameter, severe calcification, and fake shadow. According to the CAG result, the sensitivity and specificity of CTA by 64-slice CT for detecting stenosis greater than 50% were 90.76% and 84.97% respectively. One ease of contrast-induced nephropathy was found after CTA and 5 after CAG. Conclusion The patients with high possibility of a CHD episode are strongly recommended to take a CAG testing.