50岁以上Stanford B型主动脉夹层患者中冠心病的患病分析及其对预后的影响

Prevalence and impact of concomitant coronary artery disease in aged patients with Stanford type B aortic dissection

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。

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.