冠状动脉扩张症患者的临床特征及新分型指导介入治疗的效果观察

目的:总结51例冠状动脉扩张症(CAE)患者新分型临床特点及指导介入治疗的临床疗效。方法:回顾性分析我院2015年1月至2019年1月出院诊断含CAE且冠状动脉造影结果均符合CAE诊断标准患者51例。收集临床资料,按CAE新分型分类,随访主要不良心血管事件(MACE),其定义为全因死亡、心原性死亡、心肌梗死、血运重建的复合终点。结果:51例CAE患者中,36例(70.6%)临床表现为急性冠状动脉综合征,11例(21.6%)有CAE相关陈旧性心肌梗死。共69处冠状动脉扩张病变。CAE新分型结果如下:Ⅰ型:0例患者;Ⅱ型:1例(2.0%),1处(1.4%)冠状动脉扩张病变;Ⅲ型:20例(39.2%),36处(52.2%)冠状动脉扩张病变;Ⅳ型:14例(27.5%),14处(20.3%)冠状动脉扩张病变;Ⅴ型:16例(31.4%),18处(26.1%)冠状动脉扩张病变。依据CAE新分型指导介入治疗60处(87.0%),药物治疗9处(13.0%),手术成功率100%。中位随访时间13(6,36)个月,随访期间发生MACE 7例(13.7%),其中心肌梗死2例(3.9%),血运重建治疗5例(9.8%),均为非靶血管相关事件。结论:CAE患者多以急性冠状动脉综合征为主要表现,CAE新分型中Ⅲ型发病率较高,新分型指导CAE介入治疗临床效果满意。

Clinical and Angiographic Characteristics and Therapeutic Effect Guided by the New Classification System in 51 Patients With Coronary Artery Ectasia

Objectives:To summarize the clinical and angiographic characteristics of 51 cases with coronary artery ectasia(CAE)and the therapeutic efficacy guided by new classification system.Methods:51 patients diagnosed with coronary artery ectasia from January 2015 to January 2019 by coronary angiography were included in this study.The clinical data,angiographic features and follow-up results of major adverse cardiovascular events(MACE)were investigated among various types of CAE defined by new classification system.The MACE was defined as all-cause death,cardiac death,myocardial infarction,revascularization.Results:Among a total of 51 cases with 69 CAE lesions,36 cases(70.6%)presented as acute coronary syndrome(ACS).11 cases(21.6%)had CAE-related myocardial infarction history.The frequency of each CAE type by the new classification was as follows:Ⅰ:0(0%),Ⅱ:1 cases(2.0%)with 1 CAE(1.4%)lesion,Ⅲ:20 cases(39.2%)with 36 CAE(52.2%)lesions,Ⅳ:14 cases(27.5%)with 14 CAE(20.3%)lesions,Ⅴ:16 cases(31.4%)with 18 CAE(26.1%)lesions.9 CAE(13.0%)lesions were treated by medicine therapy and 60 lesions(87.0%)underwent interventional therapy with a 100%success rate.The median time of follow-up was 13(6,36)months.Seven overall major adverse cardiovascular events occurred(13.7%)during follow-up,which were non-targeted vessel related events,including 2 cases(3.9%)myocardial infarction and 5 cases(9.8%)revascularization.Conclusions:ACS is the major clinical manifestation of CAE,most often in patients with type Ⅲ CAE.Clinical outcome of interventional therapy guided by the new CAE classification is satisfactory for CAE patients.