Incidence and predictors of silent embolic cerebral infarction following diagnostic coronary angiography
Incidence and predictors of silent embolic cerebral infarction following diagnostic coronary angiography
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DOI：
10.1016/j.ijcard.2009.10.053
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发表时间：
2011-04-14
影响因子：
3.5
通讯作者：
Kim, Kwon-Bae
中科院分区：
文献类型：
--
作者：
Kim, In-Cheol;Hur, Seung-Ho;Kim, Kwon-Bae
背景：冠状动脉造影术(CAG)是一种有创的诊断方法，会导致与手术相关的并发症。众所周知的术后并发症之一是有症状或无症状的脑梗塞。无症状性栓塞性脑梗塞(SECI)具有临床意义，因为它可以进展到认知功能的下降，并在长期内增加痴呆的风险。本研究的目的是利用弥散加权磁共振成像(DW-MRI)检测诊断CAG后SECI的发生率和预测因素。方法：对197例冠状动脉搭桥术前行DW-MRI检查以评估颅内血管病变的冠心病患者进行回顾性研究。诊断CAG后48h内行DW-MRI检查。SECI在DW-MRI上表现为局灶亮信号高信号。根据有无SECI(+SECI和-SECI)将患者分组。结果：197例患者中，20例(10.2%)在诊断CAG后发生SECI。在+SECI组和-SECI组之间，年龄、女性、潜在房颤频率、冠状动脉病变程度和诊断CAG期间的透视时间没有差异。+Seci组的左心室射血分数显著低于-Seci组(45.9+/-8.5%vs.51.4+/-13.1%，p=0.014)，内乳动脉血管造影率显著高于-seci组(85%vs.37.2%，p<；0.001)。多因素分析显示，颈动脉造影是闭合性颈动脉闭塞的唯一预测因素(OR=14.642；95%CI=3.201~66.980，p=0.001)。结论：诊断CAG后闭合性闭塞的发生率并不罕见。IMA血管造影术诊断CAG可能增加SECI的风险。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Coronary angiography (CAG) is an invasive diagnostic procedure, which could lead to procedure related complications. One of the well known post-procedural complications is cerebral embolic infarction with or without symptoms. Silent embolic cerebral infarction (SECI) has clinical significance because it can progress to a decline in cognitive function and increase the risk of dementia in the long term. The aim of this study was to detect the incidence and predictors of SECI after diagnostic CAG using diffusion-weighted magnetic resonance imaging (DW-MRI).Methods: A total of 197 patients with coronary artery disease who underwent DW-MRI for evaluation of intracranial vasculopathy before coronary artery bypass graft surgery were retrospectively enrolled in the present study. DW-MRI was performed within 48 h after diagnostic CAG. SECI was diagnosed as presence of focal bright high signal intensity in DW-MRI. Patients were divided into groups according to presence/absence of SECI (+ SECI vs. - SECI, respectively). The clinical and angiographic characteristics were analyzed and independent predictors were evaluated.Results: Of the 197 patients, SECI occurred in 20 patients (10.2%) after diagnostic CAG. Age, female gender, frequency of underlying atrial fibrillation, extent of coronary disease, and fluoroscopic time during diagnostic CAG were not different between the + SECI and - SECI groups. Left ventricular ejection fraction was significantly lower in the + SECI group than in the - SECI group (45.9 +/- 8.5% vs. 51.4 +/- 13.1%, p = 0.014) and performance rate of internal mammary artery (IMA) angiography was significantly higher in the + SECI group compared with the - SECI group (85% vs. 37.2%, p < 0.001). By multivariate analysis, performing IMA angiography was the only predictor of SECI (OR = 14.642; 95% CI = 3.201 to 66.980, p = 0.001).Conclusions: The incidence of SECI after diagnostic CAG was not infrequent. Diagnostic CAG with IMA angiography may increase the risk of SECI. (C) 2009 Elsevier Ireland Ltd. All rights reserved.