Objective: To estimate the prevalence and the risk factors of preoperative coronary angiography (CAG) confirmed coronary stenosis in patients with degenerative valvular heart disease. Methods: A total of 491 patients who underwent screening CAG before valvular surgery due to degenerative valvular heart disease were enrolled from January 2011 to September 2014 in our hospital, and clinical data were analyzed. According to CAG results, patients were divided into positive CAG result (PCAG) group or negative CAG (NCAG) group. Positive CAG result was defined as stenosis ≥50% of the diameter of the left main coronary artery or stenosis ≥70% of the diameter of left anterior descending, left circumflex artery, and right coronary artery.Risk factors of positive CAG result were analyzed by multivariable logistic regression analysis, and Bootstrap method was used to verify the results. Results: There were 47(9.57%)degenerative valvular heart disease patients with PCAG. Patients were older ((68.0±7.6)years vs.(62.6±7.1)years, P<0.001) and the prevalence of typical angina was significantly higher (14.89%(7/47)vs. 2.03%(9/444), P<0.001)in PCAG group than in NCAG group. Multivariable logistic regression analysis showed that age (OR=1.118, 95%CI 1.067-1.172, P<0.001), typical angina (OR=8.970, 95%CI 2.963-27.154, P<0.001), and serum concentration of apolipoprotein B (OR=20.311, 95%CI 4.774-86.416, P<0.001) were the independent risk factors of PCAG in degenerative valvular heart disease patients. Bootstrap method revealed satisfactory repeatability of multivariable logistic regression analysis results (age: OR=1.118, 95%CI 1.068-1.178, P=0.001; typical angina: OR=8.970, 95%CI 2.338-35.891, P=0.001; serum concentration of apolipoprotein B: OR=20.311, 95%CI 4.639-91.977, P=0.001). Conclusions: A low prevalence of PCAG before valvular surgery is observed in degenerative valvular heart disease patients in this patient cohort. Age, typical angina, and serum concentration of apolipoprotein B are independent risk factors of PCAG in this patient cohort.
目的： 了解退行性心脏瓣膜病患者外科手术前冠状动脉造影阳性率及其相关因素。 方法： 入选南京大学医学院附属鼓楼医院2011年1月至2014年9月外科手术前行冠状动脉造影的退行性心脏瓣膜病患者491例，对其临床资料进行回顾性分析。根据术前冠状动脉造影结果，将退行性心脏瓣膜病患者分为冠状动脉造影阳性组和冠状动脉造影阴性组。冠状动脉造影阳性定义为左主干狭窄≥50%或左前降支、左回旋支、右冠状动脉任意一支或多支狭窄程度≥70%。采用logistic回归分析法分析退行性心脏瓣膜病患者冠状动脉造影阳性的独立相关因素，并采用Bootstrap方法进行验证。 结果： 退行性心脏瓣膜病患者术前冠状动脉造影阳性率为9.57%(47/491)。冠状动脉造影阳性组患者年龄大于冠状动脉造影阴性组[(68.0±7.6)岁比(62.6±7.1)岁，P<0.001]，典型心绞痛症状比率高于冠状动脉造影阴性组[14.89%(7/47)比2.03%(9/444)，P<0.001]。多因素logistic回归分析显示，年龄(OR＝1.118, 95%CI 1.067～1.172，P<0.001)、典型心绞痛症状(OR＝8.970, 95%CI 2.963～27.154，P<0.001)和血清载脂蛋白B浓度(OR＝20.311, 95%CI 4.774～86.416，P<0.001)与退行性心脏瓣膜病患者冠状动脉造影阳性独立相关；Bootstrap方法显示，多因素logistic回归分析结果具有可重复性(年龄：OR＝1.118, 95%CI 1.068～1.178，P＝0.001；典型心绞痛症状：OR＝8.970, 95%CI 2.338～35.891，P＝0.001；血清载脂蛋白B浓度：OR＝20.311, 95%CI 4.639～91.977，P＝0.001)。 结论： 本研究退行性心脏瓣膜病患者外科手术前冠状动脉造影阳性率低；年龄、血清载脂蛋白B浓度及典型心绞痛症状与退行性心脏瓣膜病患者冠状动脉造影阳性独立相关。.
Keywords: Coronary angiography; Coronary disease; Heart valve diseases.