高龄急性冠脉综合征患者血运重建问题初探

Revascularization for acute coronary syndromes in the elderly

目的 评价高龄急性冠脉综合征患者进行血运重建与否的近期与远期疗效。方法 对分别进行冠脉介入 (perctutaneouscoronaryintervetion ,PCI)治疗、冠脉旁路移植手术 (coronaryarterybypasssurgery ,CABG)治疗和单纯药物治疗的 1 4 6例急性冠脉综合征的、年龄≥ 75岁的患者进行近期和远期疗效分析。结果 从近期疗效看 ,CABG组的院内病死率最高 ,与PCI组和药物治疗组比较差异具有显著性 (P <0 0 5 ) ;从远期疗效看 ,没有进行血运重建的药物治疗组的远期心源性病死率最高 ,为 2 6 1 % (P <0 0 5 ) ,将三组分别进行比较 ,PCI组远期病死率显著低于药物治疗组 (P =0 0 2 6 ) ,CABG组低于药物治疗组但差异没有显著性 (P =0 0 5 8) ,而PCI组与CABG组的远期病死率没有显著差异。结论 高危的、高龄的急性冠脉综合征患者 ,可以从早期的冠脉血运重建治疗 ,尤其是冠脉介入治疗中获益 。

Objective To evaluate the outcome of revascularisation by percutaneous coronary intervention(PCI) or coronary artery bypass surgery(CABG) in the elderly with acute coronary syndromes.Methods Analysis of the short-term and long-term outcomes of PIC or CABG in patients over 75 years of age,who were diagnosed with acute coronary syndromes.Results Short term mortality in CABG group was higher than that in the PCI and conservatively treated groups,with no obvious difference observed between the latter two groups.Long term mortality in conservative treatment group was higher than that in the other two groups,and no obvious difference observed between the PCI+CABG groups.Conclusion PCI offers an attractive option for the management of older people with acute coronary syndromes and may improve outcome over conservative treatment. In contrast, coronary artery bypass carries a substantial mortality, and is likely to be reserved for patients with refractory symptoms unsuitable for percutaneous intervention.