冠心病合并代谢综合征冠脉特征及对血运重建的影响

目的探讨冠心病(Coronary artery disease,CAD)合并代谢综合征(Metaolic Suyndrome,MS)的冠脉病变特征及对血运重建的影响。方法根据冠脉造影结果,将348例冠心病患者分为CAD合并MS组及单纯CAD组,分析比较两组间冠脉病变的评分及多支病变、左主干(LM)病变、弥漫长病变、分叉病变、急慢性闭塞病变的比例和接受支架术比例、平均支架数、支架平均长度、靶血管内径及推荐冠脉搭桥术的比例。结果CAD病人MS患病率为34.5%,男女分别为33.3%、37.0%,MS组冠脉病变左回旋支(LCX)及右冠脉(RCA)平均评分、冠脉总评分、多支血管病变的比例、RCA弥漫长病变比例、LCX及RCA分叉病变比例显著高于单纯CAD组,推荐血运重建及行搭桥术比例MS组显著高于单纯CAD组(70.0%vs 57.9%、16.7%vs 5.3%),LM病变、急慢性闭塞病变及行支架术的比例两组差异无显著性,置入支架平均数及总长度MS组高于单纯CAD组,平均支架长度及靶血管平均内径两组差异无显著性。结论CAD合并MS组冠脉病变严重程度、复杂程度及对血运重建的需求显著增加,需要合理的血运重建策略。

Characteristics of coronary artery lesions in patients with coronary artery disease complicated with metabolic syndrome and their impact on revascularization

Objective To probe into the characteristics of coronary artery lesions in patients with coronary heart disease(CAD) complicated with metabolic syndrome(MS) and their impact on revascularization.Methods According to the findings on coronary artery angiography,348 cases of CAD were divided into two groups: CAD or CAD MS.All of them underwent selective coronary angiography and their severity of coronary stenosis was evaluated by scores.The scores of coronary stenosis and characteristics of coronary artery lesions and the results of revascularization was comparatively analysed between the two groups.Results The prevalence of MS was 34.5% among the 348 CAD patients,33.3% among the males and 37.0% among the females.The coronary stenosis score of LCX and RCA,the total score of coronary stenosis,frequency of the multivessel lesions,frequency of the diffused long lesions of RCA,frequency of the bifurcation lesions of LCX and RCA were significantly higher in patients with CAD MS than single CAD(P<0.01).The frequency of revascularization(70.0% vs 57.9%)and coronary artery bypass graft surgery(CABG)(16.7% vs 5.3%) were significantly higher in patients with CAD MS than CAD only(P<0.01).The frequency of LM lesions,frequency of acute or chronic total occlusion lesions and coronary stenting were not significantly different between two groups.The mean stent number and total stent length were significantly higher in patients with CAD MS than single CAD(P<0.01).The mean stent length and mean target vessel diameter were not significantly different between the two groups.Conclusion There are more severe and complex lesions in coronary artery,and therefore the requirement for revascularization is more urgent in patients with CAD complicated with MS than CAD only.Reasonable strategies of revascularization should be put into practice for these patients.