“麻花辫”样冠状动脉的治疗及预后分析

Therapy and prognosis of the“braided hair-like”coronary arteries

目的探讨“麻花辫”样冠状动脉的诊治策略及远期预后。方法纳入经冠状动脉造影证实存在“麻花辫”样冠状动脉病变的患者,根据治疗方案,将患者分为单纯药物治疗组和经皮冠状动脉介入治疗组(percutaneous coronary intervention,PCI)。回顾性分析两组患者的临床资料、影像学特点、治疗方案及随访结果,并分析其预后。结果单纯药物治疗组患者10例(52.63%);PCI组患者9例(47.37%)。与单纯药物治疗组相比,PCI组患者高密度脂蛋白胆固醇[0.75(0.64,0.99)mmol/L vs 1.11(0.83,1.30)mmol/L,P=0.037]水平降低。与单纯药物治疗组相比,PCI组患者“麻花辫”样病变支狭窄程度[(79.78±21.28)%vs(49.00±12.89)%,P=0.001]明显升高。随访期间,单纯药物治疗组和PCI组分别发生1例(10.0%)和2例(22.2%)主要不良心脑血管事件,两组患者不良心脑血管事件发生率和Kaplan-Meier生存分析差异均无统计学意义。结论“麻花辫”样冠状动脉并非完全是一种良性病变,应充分评估心肌缺血,综合患者临床症状和病变程度进行治疗,并密切随访以预防心血管不良事件的发生。

Objective To explore the treatment strategy and long-term prognosis of patients with the“braided hair like”coronary arteries.Methods Patients with the"braided hair-like"coronary arteries confirmed by coronary angiography were included.According to the treatment plan,patients were divided into two groups:drug treatment group and percutaneous coronary intervention(PCI)group.The clinical materials,imaging characteristics,treatment and follow up results of the two groups were retrospectively analyzed,and the prognosis was analyzed.Results Ten(52.63%)patients were included in the drug treatment group,and 9(47.37%)patients were included in the PCI group.Compared with the drug treatment group,the level of high-density lipoprotein cholesterol in the PCI group was lower[0.75(0.64,0.99)mM vs 1.11(0.83,1.30)mM,P=0.037].Compared with the drug treatment group,the degree of stenosis of"braided"lesions in the PCI group was significantly higher than that in the drug treatment group[(79.78±21.28)%vs(49.00±12.89)%,P=0.001].During the follow-up period,1 case(10.0%)and 2 cases(22.2%)of major adverse cardiovascular and cerebrovascular event occurred in the drug treatment group and PCI group respectively.There was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular event and Kaplan Meier survival analysis between the two groups.Conclusion The“braided hair-like”coronary arteries were not completely benign.Myocardial ischemia should be carefully evaluated,appropriate treatment should be selected according to the clinical symptoms and the degree of stenosis.Follow-up should be carried out to prevent the cardiovascular adverse events.