药物洗脱支架治疗老年女性多支冠脉病变的临床研究

Clinical investigation of drug-eluting stent in treatment of elderly female patients with multi-vessel coronary artery disease

目的探讨药物洗脱支架(DES)治疗老年女性多支冠状动脉病变的疗效及安全性。方法2002年10月～2005年6月经冠脉造影证实为多支冠状动脉病变老年(≥65岁)女性患者387例,均行经皮冠状动脉介入治疗(PCI),其中DES组139例,普通金属支架(BMS)组248例。比较两组支架术后近期及远期的临床疗效。结果DES组糖尿病患者的比例明显高于BMS组(42.4%vs29.8%,P<0.05)。两组高血压病和心功能不全的比例、冠状动脉病变的严重程度、PCI成功率及并发症发生率均无统计学差异。对371例患者随访6～36个月(20.8±12.6个月),DES组和BMS组造影随访率分别为53.7%和56.1%,无明显差异(P>0.05),但DES组复查造影再狭窄率和主要不良心脏事件(MACE)发生率均明显低于BMS组(分别为4.2%vs15.8%和7.5%vs17.3%,P<0.05)。结论老年女性多支病变患者应用多枚DES的成功率高,严重并发症少,术后再狭窄率低,长期临床疗效良好。

Objective To retrospectively analyze the effectiveness and safety of drug-eluting stents （DES） on prevention of restenosis in old female patients （≥65 years） with multi-vessel coronary artery disease. Methods 387 old female patients with multi-vessel coronary artery disease underwent percutancous coronary intervention （PCI） were divided into the DES group （n= 139） and the metallic stent （BMS） group （n=248）. Acute and long-term outcomes were compared between the two groups. Results The ratio of patients with diabetic disease was higher in DES group than that in BMS group （P〈0. 05）. The ratios of hypertension, seriousness of coronary lesion, heart function, success rates of therapeutic measures were not significantly different between the two groups. Mean follow-up duration for 371 patients was 20. 8 _--±12. 6 months. Angiographic follow-up rate was similar in the two groups （53. 7%in DES group vs 56. 1% in BMS group, P〉0. 05）. The rates of restenosis shown by angiogmphy and major adverse cardiac events （MACE） were significantly lower in the DES group compared with BMS group （4.2% vs 15.8%, 7.5% vs 17.3%, P〈0.05）. Condusion The implantation of DES inelderly female patients with multi-vessel disease can achieve high success rate, low rates of complications and restenosis and good long-term clinical outcome.