The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: A prospective study
The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: A prospective study
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DOI：
10.1016/s0735-1097(03)00579-5
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发表时间：
2003-07-16
影响因子：
24
通讯作者：
Takeshita, A
中科院分区：
文献类型：
--
作者：
Fukumoto, Y;Tsutsui, H;Takeshita, A
目的探讨胆固醇栓塞症(CES)作为心导管术后并发症的发生率及其相关危险因素。背景胆固醇栓塞症是一种因冠状动脉造影、大血管手术或溶栓术后胆固醇晶体远端大量散落而引起的全身性疾病。方法前瞻性评估11家医院接受左心导管术的1786例40岁及以上患者。当患者周围皮肤受累(网状肝、蓝趾综合征、指端坏疽)或肾功能不全时，即可诊断CES。12例(48%)有皮肤体征，16例(%)有肾功能不全。心导管插管前后CES患者的嗜酸性粒细胞计数明显高于非CES患者。住院病死率为16.0%(4例)，显著高于无CES组(0.5%，p<；0.01)。心导管术后死亡的4例CES患者均有进行性肾功能不全。单因素分析显示，有动脉粥样硬化性疾病、高血压、吸烟史和基线血浆C反应蛋白(CRP)升高的患者CES的发生率增加。股动脉入路并未增加发生率，提示升主动脉可能是潜在的栓塞源。作为CES的独立预测因素，多元回归分析仅显示术前C反应蛋白水平升高(优势比4.6，p=0.01)。结论胆固醇栓塞综合征是心导管术后较为罕见但严重的并发症。在接受血管手术的患者中，术前血浆CRP水平升高与随后的CES相关。(C)2003年，由美国心脏病学会基金会提供。
OBJECTIVES We sought to determine the incidence of cholesterol embolization syndrome (CES) as a complication of cardiac catheterization and to identify risk factors associated with this disease.BACKGROUND Cholesterol embolization syndrome is a systemic disease caused by distal showering of cholesterol crystals after angiography, major vessel surgery, or thrombolysis.METHODS We prospectively evaluated a total of 1,786 consecutive patients 40 years of age and older, who underwent left-heart catheterization at 11 participating hospitals. The diagnosis of CES was made when patients had peripheral cutaneous involvement (livedo reticularis, blue toe syndrome, and digital gangrene) or renal dysfunction.RESULTS Twenty-five patients (1.4%) were diagnosed as having CES. Twelve patients (48%) had cutaneous signs, and 16 patients (64%) had renal insufficiency. Eosinophil counts were significantly higher in CES patients than in non-CES patients before and after cardiac catheterization. The in-hospital mortality rate was 16.0% (4 patients), which was significantly higher than that without CES (0.5%, p < 0.01). All four patients with CES who died after cardiac catheterization had progressive renal dysfunction. The incidence of CES increased in patients with atherosclerotic disease, hypertension, a history of smoking, and the elevation of baseline plasma C-reactive protein (CRP) by univariate analysis. The femoral approach did not increase the incidence, suggesting a possibility that the ascending aorta may be a potential embolic source. As an independent predictor of CES, multivariate regression analysis identified only the elevation of pre-procedural CRP levels (odds ratio 4.6, p = 0.01).CONCLUSIONS Cholesterol embolization syndrome is a relatively rare but serious complication after cardiac catheterization. Elevated plasma levels of pre-procedural CRP are associated with subsequent CES in patients who undergo vascular procedures. (C) 2003 by the American College of Cardiology Foundation.