高龄冠状动脉性心脏病患者临床及冠状动脉造影结果分析

Analysis of the clinical and coronary angiographic features in patients over 80 years old with coronary heart disease

目的 :探讨高龄冠状动脉性心脏病 (CHD)的临床及影像学特点。 方法 :对 13例 80岁以上CHD患者进行回顾性研究分析。 结果 :本组均为男性 ,合并原发性高血压、高脂血症及糖尿病者分别为 84 .6 %、6 1.5 %和15 .4 %。有吸烟史者占 30 .8%。典型胸痛、不典型胸痛及无胸痛者分别为 6 1.5 %、7.7%和 30 .8%。胸部X线片、心脏超声、心电图及肾功能异常者分别为 84 .6 %、92 .3%、92 .3%和 5 3.8%。CAG显示 :冠状动脉 (CA)为右优势分布者 8例 ,占 6 1.5 % ;左优势分布者 2例 ,占 15 .4 % ;均衡型分布者 3例 ,占 2 3.1%。病变累及CA 2 7支共 36处 ,单支病变占 15 .4 %、2支病变占 4 6 .2 %、多支病变占 38.5 % ,受累的左前降支 (LAD)、右CA(RCA)及左回旋支 (LCX)分别为 4 4 .4 %、33.3%和 2 2 .2 %。A型病变累及CA 6支 12处 (33.3% )、B型病变累及CA 12支 15处 (4 1.7% )、C型病变累及CA 9支 9处 (2 5 % ) ,重度以上狭窄占 5 9.2 %。9例 (6 9.2 % )有不同程度的侧支循环 ,其中 4例 (30 .8% )为 3级。 结论 :80岁以上高龄CHD患者 ,多合并危险因素 ,临床表现可不典型 ,临床检查多有异常 ,CA分布以右优势型居多 ,CA病变以 2支及多支病变为主 ,B型及C型病变占多数、CA狭窄程度较严重 。

Objective:To explore the relationship between clinical characteristics and results of coronary angiography in the aged patients with coronary heart diease(CHD). Methods:Retrospective analysis was performed in 13 patients over 80 years old with coronary heart diease. Results:All of the patients were men.The history of hypertention, hyperlipemia,diabetes mellitus and cigarette-smoking, accounted for 84.6%, 61.5% ,15.4% and 30.8% of 13 total cases respectively.Those with typical chest pain,atypical chest pain and no chest pain accounted for 61.5%,7.7% and 30.8% respectively.Abnormal chest X-ray,echocardiography,electrocardiogram and kidney function were found in 84.6%,92.3%, 92.3% and 53.8% of the total cases respectively.Coronary angiography(CAG) showed that the right coronary artery(RCA) dominated distribution were 8 cases (61.5%),the left coronary artery(LCA)dominated were 2 cases (15.4%),and the balanced were 3 cases (23.1%).CAG showed that there were 27 stenotic coronary arteries with 36 target lesions in the patients,including 12 (33.3%)type A lesions in 6 branches, 15(41.7%) type B lesions in 12 branches and 9(25%)type C lesions in 9 branches.Narrowness with the single branch lesion,two-branch lesion and multiple branch lesions accounted for 15.4%, 46.2% and 38.5% respectively,the frequency of involved vessels detected on angiograms ranked,in descending order,as LCA,RCA and LCX,and seriously narrowed lesions accounted for 59.2%. Different degree of collateral circulation was found in 9 cases (69.2%),and 4(30.8%) of them were degree 3. Conclusion:Most of the patients with CHD of over 80 years old had more risk factors,the clinical feature might be atypical,and the cinical examination were often abnormal.The distribution of coronary artery was often RCA dominated.Two-branch and multiple branch lesions were involved in most patients ,the degree of narrowness was often severe. The type B and type C lesion,and different degree of callateral circulation were found in most cases.