青年冠心病临床、冠状动脉造影特点及介入治疗(摘要)

中国循环杂志 1999年第0期第14卷 摘要　冠心病介入治疗

作者：郭金成　庞绍泉　张维君

单位：北京市，通州区潞河医院　心内科(101149)　郭金成；首都医科大学附属北京安贞医院　庞绍泉　张维君

　　目的：探讨青年冠心病的临床、冠状动脉造影特点及介入治疗的效果。

　　方法：94例年龄≤40岁的冠心病患者，男性87例，女性7例，平均年龄36.4±4.3(23～40)岁，其中临床诊断心绞痛且被冠状动脉造影证实血管狭窄≥50%患者43例，心肌梗塞患者51例，均进行了冠状动脉造影。23例患者进行了经皮冠状动脉腔内成形术(PTCA)。

　　结果：冠心病危险因素：吸烟者占69.2%(65/94),饮酒者32.4%(30/94),高密度脂蛋白(＜35 mg/dl)占35.6%(33/94),少数有高血压、高胆固醇、糖尿病及冠心病家族史，吸毒1例，胸外伤致心肌梗塞1例。发病前有明显诱因者58%(54/94)。冠状动脉造影证实：冠状动脉造影正常者12.8%(12/94),单支病变47.9%(45/94),双支病变22.3%(21/94),三支病变10.6%(10/94)。介入治疗：23例患者进行了PTCA术，共扩张25支血管，34处病变，置入支架15枚，病例成功率95.6%(22/23),血管成功率96.0%(24/25),病变成功率94.1%(32/34),其中完全血运重建15例，部分血运重建8例，随访12.2(1～30)个月，84%心绞痛消失，5例术后3个月至2年内造影示再狭窄。

　　结论：青年冠心病患者多有吸烟史，以单支血管病变为主，发病前多有明显诱因，PTCA可明显缓解心绞痛症状，有助于提高生活质量，改善预后。

Clinical Profile, Coronary Angiographic findings and Intervention Outcome in Young Patients with Coronary Artery Disease(Abstract)

Department of Cardiology, Luhe Hospital, beijing (101149)

　　guo Jincheng, Pang Shaoquan, Zhang Weijun.

　　objective: To assess the clinical, angiographic and intervention findings of patients younger than 40 years of age.

　　Methods: Among the 94 young patients undergoing coronary angiography, there were 87 males and 7 females with a mean age of 36.4±4.3(23～40) years. 43 patients who had angina pectoris without myocardial infarction were selected because of presence of ＞50% narrowing in one or more vessels. Of the remaining 51 patients who had previous myocardial infarction, percutenous transluminal coronary angioplasty (PTCA) was performed in 23 patients.

　　Results: The most frequent risk factors documented in this study in descending order were smoking (69.2%)、 lower high density lipoprotein (HDL) (35.6%)、 excessive drinking (32.4%) as well as family history of coronary artery disease、 hypertension、 hypercholesterolemia、 diabetes mellitus. Drug abuse occurred in one case, myocardial infarction associated with chest trauma in one case. Angiography showed the prevalence rate of one-, two- and three-vessel disease was 47.9%, 22.3% and 10.6%, respectively. PTCA was performed in 23 patients with 25 diseased vessels and 34 lesions, 15 stents were implanted into 8 LAD, 3 stents into LCX and 4 stents into RCA, the clinical(patient) and technical (vessel) success rate was 95.6%, 96.0%, respectively. 15 patients had complete vessel revascularization of the ischemia-related vessels and 8 patients had imcomplete vessel revascularization. During a 12-month follow up, 84% of the patients were free from symptoms, 5 patients had chest pain with confirmed restenosis.

　　Conclusion: In our young patients with coronary artery disease there is a high prevalence of cigarette smoking, a high percentage of single-vessel disease, and certain predisposing factors appear to be present prior to the onset of symptoms in most patients. PTCA is an effective and relatively safer intervention procedure for young patients with coronary disease.