Analysis of risk factors in patients with coronary artery aneurysm combined with acute myocardial infarction
-
摘要: 目的 研究冠状动脉瘤样扩张(CAE)合并急性心肌梗死(AMI)患者的危险因素。方法 回顾性分析2017年1月—2023年12月在襄阳市中心医院心血管内科住院并实施冠状动脉(冠脉)造影的患者，并筛选出CAE患者170例，根据是否发生AMI分为CAE组(112例)和CAE+AMI组(58例)。比较两组患者的临床资料，进行Spearman相关性分析和logistic回归分析。结果 170例CAE患者中，单支CAE最常见，以右冠脉(RCA)受累最多(57支，占33.5%)。两组患者在吸烟史、抗血小板药物使用率、低密度脂蛋白胆固醇(LDL-C)、心肌肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞计数(Neu)、中性粒细胞与淋巴细胞比值(NLR)等方面存在显著差异(P < 0.05)。Spearman相关性分析显示，LDL-C、CRP、WBC、Neu与cTnI、CK、CK-MB均呈正相关。Logistic回归分析显示，吸烟、抗血小板药物使用率低、高LDL-C以及CRP是CAE患者发生AMI的危险因素(P < 0.05)。结论 吸烟、抗血小板药物使用率低、LDL-C以及CRP高是CAE患者发生AMI的危险因素。Abstract: Objective To investigate the risk factors in patients with coronary aneurysmal dilation(CAE) complicated with acute myocardial infarction(AMI).Methods Retrospective analysis was performed on patients admitted to the cardiovascular Department of Xiangyang Central Hospital from January 2017 to December 2023 who underwent coronary artery angiography, and 170 CAE patients were screened out and divided into CAE group(112 cases) and CAE+AMI group(58 cases) according to whether AMI occurred. The clinical data of the two groups were compared. Spearman correlation analysis and logistic regression analysis were performed.Results In 170 CAE patients, single-vessel coronary angiomatous dilatation was the most common, and the right coronary artery(RCA) was the most involved(57 vessels, accounting for 33.5%). There were significant differences in smoking history, use rate of antiplatelet drugs, low density lipoprotein cholesterol(LDL-C), myocardial troponin I(cTnI), creatine kinase(CK), creatine kinase isoenzyme(CK-MB), C-reactive protein(CRP), white blood cell count(WBC), neutrophil count(Neu), and neutrophil to lymphocyte ratio(NLR)(P < 0.05). Spearman correlation analysis showed that LDL-C, CRP, WBC, Neu were positively correlated with cTnI, CK, and CK-MB. Logistic regression analysis showed that smoking, low utilization rate of antiplatelet drugs, high LDL-C and CRP were risk factors for AMI in CAE patients(P < 0.05).Conclusion Smoking, low utilization rate of antiplatelet drugs, high LDL-C and CRP are risk factors for AMI in CAE patients.
-
Key words:
- coronary artery ectasia /
- acute myocardial infarction /
- risk factors
-
-
表 1 两组患者的临床资料比较
Table 1. Clinical data
例(%), X±S, M(P25, P75) 项目 CAE+AMI组(58例) CAE组(112例) P 女/男/例 13/45 30/82 0.535 高血压史 32(55) 74(66) 0.166 糖尿病史 16(27) 26(23) 0.532 心房颤动史 9(15) 7(6) 0.050 吸烟史 29(50) 26(23) < 0.001 抗血小板药物 13(22) 71(63) < 0.001 他汀类 17(29) 53(47) 0.024 ACEI/ARB 10(17) 42(37) 0.007 年龄/岁 60.81±14.5 61.43±10.31 0.773 TG/(mmol/L) 1.26(0.97，1.75) 1.37(1.07，2.19) 0.118 TC/(mmol/L) 4.63(3.58，5.3) 4.28(3.64，4.84) 0.115 HDL-C/(mmol/L) 0.94(0.77，1.11) 1.03(0.86，1.24) 0.005 LDL-C/(mmol/L) 3.2(2.6，4.31) 2.03(1.54，2.49) < 0.001 尿素氮/(mmol/L) 5.7(4.57，7.67) 5.8(4.82，7.0) 0.957 肌酐/(μmol/L) 79.8(68.0，93.2) 78.3(66.7，92.5) 0.709 尿酸/(μmol/L) 347.5(289.9，429.3) 370.4(320.9，426.9) 0.209 白蛋白/(g/L) 37.5(34.7，40.6) 40(38.3，43.0) < 0.001 空腹血糖/(mmol/L) 5.75(4.95，7.62) 5.22(4.84，6.4) 0.082 CRP/(mg/L) 17.6(5.38，42.1) 1.4(0.47，2.22) 0.007 WBC/(×109/L) 8.41(6.97，10.78) 6.14(5.09，7.17) < 0.001 Neu/(×109/L) 5.94(4.63，8.72) 3.61(2.81，4.67) < 0.001 Lym/(×109/L) 1.58(1.02，2.13) 1.66(1.37，2.18) 0.082 NLR 3.79(2.53，6.50) 2.06(1.52，2.94) < 0.001 血红蛋白/(g/L) 137(124，148) 138(126，147) 0.730 血小板/(×109/L) 204±65 204±61 0.954 cTnI/(ng/L) 6.48(1.14，10.39) 0.1(0.1，0.1) < 0.001 CK/(U/L) 447.5(162.5，1 110) 87.4(60，129.5) < 0.001 CK-MB/(U/L) 41.3(25.2，109.5) 12(10，16.5) < 0.001 
下载: 导出CSV
表 2 冠脉造影相关特征
Table 2. Characteristics related to coronary angiography
例(%) 累计血管分布 例数(170例) 组别 P CAE组(112例) CAE+AMI组(58例) 右冠脉 57(33.5) 35(31.2) 22(37.9) 0.383 前降支 54(31.8) 36(32.1) 18(31.0) 0.883 回旋支 16(9.4) 11(9.8) 5(8.6) 0.800 左主干 3(1.8) 3(2.7) 0 0.210 右冠+前降支 14(8.2) 10(8.9) 4(7.0) 0.649 右冠+回旋支 10(5.9) 5(4.5) 5(8.6) 0.276 前降支+回旋支 7(4.1) 4(3.6) 3(5.2) 0.619 左主干+前降支 1(0.6) 1(0.9) 0 0.472 左主干+回旋支 1(0.6) 1(0.9) 0 0.472 3支病变 7(4.1) 6(5.4) 1(1.7) 0.260
下载: 导出CSV
表 3 危险因素的logistic回归分析
Table 3. Logistic analysis of risk factors
变量 B SE Wald P OR(95%CI) 吸烟史 2.966 1.087 7.444 0.006 19.408(2.305~163.39) 抗血小板药物使用率 -2.167 1.095 3.921 0.048 0.114(0.013~0.978) ACEI/ARB药物使用率 -2.117 1.469 2.076 0.150 0.120(0.007~2.144) LDL-C 1.736 0.517 11.282 < 0.001 5.676(2.061~15.634) CRP 0.817 0.237 11.931 < 0.001 2.264(1.424~3.601) 白蛋白 -0.203 0.135 2.263 0.132 0.816(0.626~1.063)
下载: 导出CSV
-
[1] 刘磊, 叶梓, 刘学波. 冠状动脉瘤样扩张的研究进展[J]. 中国心血管杂志, 2022, 27(3): 292-295.
[2] 王石雄, 李勇男, 罗伟, 等. 外科手术治疗巨大右冠状动脉瘤合并右房瘘1例[J]. 临床心血管病杂志, 2022, 38(8): 684-686. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.08.017
[3] 李晗, 况春燕. 青少年川崎病合并冠状动脉3支病变1例[J]. 临床心血管病杂志, 2024, 40(2): 154-157. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2024.02.013
[4] Eid MM, Mostafa MR, Alabdouh A, et al. Long-term outcomes of acute myocardial infarction in pre-existing coronary artery ectasia: a systematic review and meta-analysis[J]. Curr Probl Cardiol, 2023, 48(5): 101626. doi: 10.1016/j.cpcardiol.2023.101626
[5] 黄柳海, 徐冰, 何胜虎. 冠状动脉瘤内血栓形成致急性下壁心肌梗死1例[J]. 临床心血管病杂志, 2020, 36(11): 1068-1070. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2020.11.022
[6] Sheng Q, Zhao H, Wu S, et al. Underlying factors relating to acute myocardial infarction for coronary artery ectasia patients[J]. Medicine, 2020, 99(36): e21983. doi: 10.1097/MD.0000000000021983
[7] Wang X, Montero-Cabezas JM, Mandurino-Mirizzi A, et al. Prevalence and long-term outcomes of patients with coronary artery ectasia presenting with acute myocardial infarction[J]. Am J Cardiol, 2021, 156(1): 9-15.
[8] Liang S, Zhang Y, Gao X, et al. Is Coronary artery ectasia a thrombotic disease?[J]. Angiology, 2019, 70(1): 62-68. doi: 10.1177/0003319718782807
[9] Liu R, Gao X, Liang S, et al. Five-years' prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study[J]. Front Cardiovasc Med, 2022, 9(1): 950291.
[10] Gunasekaran P, Stanojevic D, Drees T, et al. Prognostic significance, angiographic characteristics and impact of antithrombotic and anticoagulant therapy on outcomes in high versus low grade coronary artery ectasia: A long-term follow-up study[J]. Catheter Cardiovasc Interv, 2019, 93(7): 1219-1227.
[11] Lee J, Seo J, Shin YH, et al. ST-segment elevation myocardial infarction in Kawasaki disease: A case report and review of literature[J]. World J Clin Cases, 2022, 10(26): 9368-9377.
[12] Richards GHC, Hong KL, Henein MY, et al. Coronary artery ectasia: review of the non-atherosclerotic molecular and pathophysiologic concepts[J]. Int J MolSci, 2022, 23(9): 5195.
[13] Abou Sherif S, Ozden Tok O, Taşköylü Ö, et al. Coronary artery aneurysms: a review of the epidemiology, pathophysiology, diagnosis, and treatment[J]. Front Cardiovasc Med, 2017, 4(1): 24.
[14] Fu FF, Chen X, Xing L. Association between ratio of white blood cells to mean platelet volume and coronary artery ectasia[J]. Angiology, 2023, 26(1): 331-347.
[15] Jiang L, Wei W, Kang S, et al. Insights into lipid metabolism and immune-inflammatory responses in the pathogenesis of coronary artery ectasia[J]. Front Physiol, 2023, 14(1): 1096991.
[16] Dereli S, Çerik B, Kaya A, et al. Assessment of the relationship between c-reactive protein-to-albumin ratio and the presence and severity of isolated coronary artery ectasia[J]. Angiology, 2020, 71(9): 840-846.
[17] Khedr A, Neupane B, Proskuriakova E, et al. Pharmacologic management of coronary artery ectasia[J]. Cureus, 2021, 13(9): e17832.
[18] Núñez-Gil IJ, Cerrato E, Bollati M, et al. Coronary artery aneurysms, insights from the international coronary artery aneurysm registry(CAAR)[J]. Int J Cardiol, 2020, 299(1): 49-55.
[19] DoiT, Kataoka Y, Noguchi T, et al. Coronary artery ectasia predicts future cardiac events in patients with acute myocardial infarction[J]. Arterioscler Thromb Vasc Biol, 2017, 37(12): 2350-2355.
-
图(2)
表(3)
计量
- 文章访问数: 569
- PDF下载数: 208
- 施引文献: 0