冠状动脉造影病变特征与急性冠脉综合征猝死的相关性分析

摘要

目的 分析急性冠脉综合征(acute coronary syndrome,ACS)猝死(sudden cardiac death,SCD)患者冠状动脉造影基本影像学特征,探讨其作为ACS猝死危险评估的价值.方法 收集2000-01～2010-12在广西医科大学第一附属医院心研所收治的ACS发生猝死患者共52例,于猝死发作前后1个月内曾行选择性冠状动脉造影.分析冠脉造影病变的特征(病变支数、分布部位、IRA形态改变等因素)与ACS猝死的相关性.结果.冠脉造影,单支、双支和多支病变者分别为15、14和23例,合并左主干病变者7例;IRA狭窄程度为完全闭塞、次全闭塞、严重狭窄、临界狭窄者分别为29、14、6和3例;IRA的冠脉病变呈弥漫性、管状和局限性分别为29、13和10例;IRA分布部位,LAD、RCA、LCX分别为16、30和6例,合并左主干病变者7例,IRA发现血栓14例.冠脉病变支数、IRA长度、合并左主干病变、IRA狭窄程度及IRA分布差异有统计学意义(P值均<0.05);冠脉病变支数、IRA狭窄程度、IRA分布对冠心病猝死发生影响具有统计学意义(P<0.05).结论.ACS患者猝死多存在多支和严重的冠脉病变基础,IRA病变狭窄程度较重,需要紧急血运重建.%Objective To assess ihe angiographic characlerislics of coronary lesions in palienls wilh acule coronary syndrome who experienced sudden heart arresl and evaluale ihe significance of coronary angiography on risk slralificalion of ACS. Methods The dala of 52 conseculive palienls wilh acule coronary syndrome experienced sudden heart arresl underwent coronary angiography a monlh wilhin ihe cardiac arresl allack were collected and ihe severity of slenosis , ihe location and ihe length of ihe coronory lesions were evaluated. Results Single faclor tesl shows thai location, ihe severity of slenosis, the lenglh of lesion of IRA and the number of culpril vessel enter ihe formula (P < 0. 05) , and then location , the severity of stenosis of IRA and ihe number of culprit vessel are associated wilh a increased risk of SCD by mulli - faclor logislic regression analysis. Conclusion Our study shows lhal palients wilh ACS experienced sudden coronary death usually suffer mulli - vessel lesions wilh more severe slenosis of IRA, Coronary angiography may serve as a reference on risk slralificalion for sudden coronary dealh.