老年Standford B型主动脉夹层患者冠状动脉造影的临床意义

Clinical significance of coronary angiography in elderly patients with Stanford type B aortic dissection

目的探讨老年Standford B型主动脉夹层患者中冠状动脉粥样硬化性心脏病(冠心病)的检出率及其相关危险因素。方法回顾性分析134例50岁以上同时进行主动脉造影和冠状动脉造影的Standford B型主动脉夹层患者的临床资料及影像学资料,对数据进行统计分析。结果134例患者中,冠心病的检出率为26.1%(35例),其中单支病变22例(16.4%),2支病变9例(6.7%),左主干或3支病变4例(3.0%)。多因素Logistic回归分析显示,男性(OR=6.682,95%CI 1.01～44.13,P=0.049)及吸烟(OR=3.513,95%CI 1.05～11.70,P=0.041)是Standford B型主动脉夹层合并冠心病的预测因素。结论 50岁以上Standford B型主动脉夹层患者共患冠心病的比例较高,在主动脉造影时有必要常规进行冠状动脉造影检查,以免漏诊。

Objectives To explore the prevalence of coronary artery disease （CAD） and its predictors in elderly patients with Stanford type B aortic dissection. Methods Clinical and image data of 134 patients who were more than 50 years old with Stanford type B aortic dissection and underwent coronary angiography immediately after aortography were retrospectively analyzed. The data were treated by statistical analysis. Results Of the 134 patients, coronary angiography showed 35 patients （26.1%） had CAD： 22 （16.4%） with single-vessel disease, 9 （6.7%） with multiple- vessel disease, 4 （3.0%） with triple-vessel disease or left main coronary disease. Multivariate Logistic analysis showed that male （OR=6.682, 95% CI 1.01-44.13, P=0.049） and smoking （0R=3.513, 95% CI 1.05-11.70, P=0.041） were predictors of Stanford type B aortic dissection with CAD. Conclusions Incidence of CAD in patients aged over 50 with Stanford type B aortic dissection is relatively high. Routine coronary angiography should be performed at the same time with aortography in order to screen this specific high risk population.