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目的探讨老年人冠状动脉(冠脉)起源异常(AOCA)的影像特征及其临床意义。方法对22例年龄≥65岁的老年AOCA患者的影像和临床资料进行回顾性分析。结果22例AOCA患者平均年龄(71±5)岁,均合并1种以上其他心血管病。其中良性AOCA17例(占77.3%),包括前降支和回旋支分别开口于左冠窦9例,回旋支起源于右冠窦3例,右冠脉起源于升主动脉3例,回旋支发育不良2例;有潜在临床危险AOCA5例(占22.7%),分别为左主干起源于右冠窦1例,右冠脉起源于左冠窦2例,单支左冠脉2例。对有潜在临床危险AOCA患者随访1～6年,未发现起源异常动脉与患者心脏事件有明确关系。结论老年人AOCA无特征性临床表现,通常在行冠脉影像学检查时被发现;老年人AO-CA似乎并不导致明显的临床后果。
Objective To investigate the imaging features of coronary artery (AOCA) in the elderly and its clinical significance. Methods A retrospective analysis was performed on the imaging and clinical data of 22 elderly AOCA patients aged 65 years or older. Results The average age of 22 AOCA patients was (71 ± 5) years old, with more than one other cardiovascular disease. Among them, 17 cases (77.3%) had benign AOCA, including 9 cases of anterior descending coronary artery and circumflex artery in the left coronary artery, 3 cases of the gyrotary branch originating from the right coronary artery, 3 cases of right coronary artery originating from the ascending aorta, 2 cases of AOCA with potential clinical risk (22.7%), respectively. The left main coronary artery originated from the right coronary sinus in 1 case. The right coronary artery originated from the left coronary sinus in 2 cases and the left coronary artery in 2 cases. AOCA patients with potential clinical risk were followed up for 1 to 6 years, and no abnormalities were found in the patients with cardiac abnormalities. CONCLUSIONS: AOCA has no characteristic clinical manifestations in elderly patients and is usually found during coronary angiography. Older AO-CA does not appear to cause significant clinical consequences.