2742例不同年龄段冠脉造影患者冠脉病变特点分析

目的总结分析各年龄段患者冠状动脉造影检查（CAG）各支冠脉血管病变的特征及差异,为临床诊治提供决策。 方法回顾性分析2013年1月至2016年12月昆明医科大学第五附属医院/红河州滇南中心医院心内科住院且行CAG的患者2742例,按年龄分为青年组（18~40岁）126例,平均年龄（35.10±4.91）岁;中年组（41~65）岁1774例,平均年龄（55.00±6.60）岁;老年组（≥66岁）842例,平均年龄（71.68±4.49岁）。运用自编的"CAG检查Epidata数据库",收集个人基本信息和冠脉数据,包括：左主干（LM）、右冠状动脉（RCA）、左前降支（LAD）、左回旋支（LCX）及各支血管的病变特征、TIMI血流情况、放置支架及手术情况,并依据美国心脏协会所制定的冠脉狭窄程度评价标准计算Gensini积分。 结果青年组、中年组和老年组患者行CAG检查的构成比分别为4.6%、64.7%、30.7%,其中以中老年人群占比最高为95.4%;3组患者男性比例（84.1%、65.8%、58.7%）、年龄[（35.10±4.91）岁、（55.00±6.60）岁、（71.68±4.49）岁]、LM病变（0.8%、5.4%、12.4%）、RCA病变（38.9%、62.5%、77.7%）、LAD病变（55.6%、81.0%、92.2%）、LCX病变（23.0%、52.5%、71.1%）比较,差异均具有统计学意义（P<0.05）;3组患者血管弥漫性病变（4.0%、5.2%、9.3%）、钙化病变（1.6%、8.2%、11.2%）、侧支循环的建立（6.3%、3.0%、15.8%）、急诊手术比例（18.3%、24.5%、20.0%）、需择期PCI术比例（6.3%、13.7%、18.9%）、手术时间[12.0（7.0,28.5）min、15.0（9.0,38.0）min、16.0（10.0,45.5）min]比较,差异均具有统计学意义（P<0.05）,而3组RCA、LM/LAD、LCX是否放支架、是否有血栓形成及是否有瘤样扩张比较,差异无统计学意义（P>0.05）。3组患者3支血管（RCA、LAD、LCX）TIMI血流为3级（RCA：61.1%、86.0%、84.9%,LAD：54.8%、75.2%、82.5%,LCX：75.4%、47.9%、62.6%）、LAD病变TIMI血流为0级（15.1%、7.7%、7.6%）、LCX病变TIMI血流为1级（1.6%、0.3%、1.7%）及2级（15.9%、1.5%、2.0%）比例比较,差异均具有统计学意义（P<0.05）。3组患者冠脉病变程度Gensini评分[5.0（0,39.8）分、13.0（4.0,35.6）分、22.0（10.0,50.0）分]比较,差异具有统计学意义（P<0.05）。而RCA病变TIMI血流0级、1级与2级,LAD病变TIMI血流1级与2级,LCX病变TIMI血流0级差异无统计学意义（P>0.05）。 结论不同年龄段患者冠脉病变有差异,随着年龄的增长,冠脉病变率增加;不同年龄段LM、RCA、LAD、LCX冠脉病变比例、弥漫病变、钙化病变、侧支循环的建立及冠脉严重程度Gensini积分随着年龄的增长而增加;3支血管以LAD病变比例最高;LCX血管病变以TIMI血流1级、TIMI血流2级的血流缓慢现象差异显著。

Coronary angiography characteristics of coronary artery lesions in 2742 patients of different ages

ObjectiveTo summarize and analyze the characteristics and differences of coronary angiography (CAG) findings in coronary artery disease patients of various age groups to help make decision-making for clinical diagnosis and treatment. MethodsA retrospective analysis was made on 2742 patients who underwent CAG at the Fifth Affiliated Hospital of Kunming Medical University/Hong-He Central Hospital of Southern Yunnan from January 2013 to December 2016. The patients were divided into a youth group [n=126; age, 18-40 years; mean age, (35.10±4.91) years], middle-aged group [n=1774; age, 41-65 years; mean age, (55.00±6.60) years], and old age group [n=842; age, ≥66 years; mean age, (71.68±4.49) years]. The self-developed CAG Epidata database was used to collect basic information and the data for coronary artery lesions, including the lesion characteristics of the left main coronary artery (LM), left anterior descending branch (LAD), left circumflex branch (LCX), and each vessel of the right coronary artery (RCA), TIMI blood flow, placement of stents, and surgery. Gensini score was calculated according to the American Heart Association′s evaluation criteria for coronary stenosis. ResultsThe composition ratios of patients in the young, middle-aged, and elderly groups were 4.6%, 64.7%, and 30.7%, respectively, with middle-aged and elderly patients accounting for the highest proportion (95.4%). The ratios of males (84.1%, 65.8%, 58.7%), age [(35.10±4.91) years, (55.00±6.60) years, (71.68±4.49) years], LM lesions (0.8%, 5.4%, 12.4%), RCA lesions (38.9%, 62.5%, 77.7%), LAD lesions (55.6%, 81.0%, 92.2%), and LCX lesions (23.0%, 52.5%, 71.1%) differed significantly among the three groups (P<0.05). The proportions of patients with diffuse vascular lesions (4.0%, 5.2%, 9.3%), calcified lesions (1.6%, 8.2%, 11.2%), established collateral circulation (6.3%, 3.0 %, 15.8%), emergency surgery (18.3 %, 24.5%, 20.0%), and elective PCI (6.3%, 13.7%, 18.9%), and operation time [12.0 (7.0, 28.5) min, 15.0 (9.0, 38.0) min, 16.0(10.0, 45.5) min] also differed significantly among the three groups (P<0.05), although RCA, LM/LAD, and LCX stenting, thrombosis, and tumor-like expansion were not statistically different (P>0.05). The percentages of patients with grade 3 TIMI blood flow in RCA, LAD, and LCX lesions [RCA: 61.1%, 86.0%, 84.9%; LAD: 54.8%, 75.2%, 82.5%; LCX: 75.4%, 47.9%, 62.6%, grade 0 TIMI blood flow in LAD lesions (15.1%, 7.7%, 7.6%), grade 1 TIMI blood flow in LCX lesions (1.6%, 0.3%, 1.7%), and grade 2 TIMI blood flow in LCX lesions (15.9%, 1.5%, 2.0%) differed significantly among the three groups (P<0.05). The Gensini scores of coronary lesions in the three groups were statistically different [5.0 (0, 39.8) scores, 13.0 (4.0, 35.6) scores, 22.0 (10.0, 50.0) scores; P<0.05], but there were no significant differences among the three groups of patients with grades 0, 1, and 2 TIMI blood flow in RCA lesions, TIMI blood flow grades 1 and 2 in LAD lesions, and grade 0 TIMI blood flow in LCX lesions (P>0.05). ConclusionCoronary lesions are different in different age groups. The incidence of coronary artery lesions increases with age. The ratios of LM, RCA, LAD and LCX coronary lesions as well as the percentages of patients with diffuse lesions, calcification lesions, collateral circulation, and severe lesions differ significantly in different age groups. Gensini score increases with age. Patients of different ages have the highest rate of LAD lesions among different arteries. LCX lesions have the most significant difference in grades 1 and 2 TIMI blood flow.