老年非ST段抬高急性冠状动脉综合征患者早期PCI的临床疗效分析

Clinical analysis of early PCI in elderly patients with non-ST-segment elevation acute coronary syndrome

目的评价老年非ST段抬高急性冠状动脉综合征(ACS)患者早期行经皮冠状动脉介入治疗(PCI)的临床疗效。方法对58例发病在48h以内的老年非ST段抬高ACS患者早期行PCI。观察患者术后主要不良心血管事件(包括再次心肌梗死、靶血管再次血管重建和死亡)的发生情况。结果冠状动脉造影(CAG)显示2支或2支以上血管病变的患者占74.14%,B型和C型病变占89.66%。58例患者共干预病变血管76支,靶病变87处,置入支架96个。56例患者手术成功,手术成功率96.55%(56/58)。对55例患者术后随访6～14个月,无心肌梗死和死亡发生。6例(10.91%)患者术后4～10个月复发心绞痛,5例行CAG复查,发现2例支架再狭窄和3例新的血管病变,对4例病变血管狭窄程度超过75%的患者进行了靶病变再次血管成形术。结论老年非ST段抬高ACS患者冠状动脉病变常为复杂、多支病变,对其早期行PCI成功率高,近期及远期疗效良好,主要不良心血管事件发生率低,安全可行。

Objective To evaluate the efficiency of early percutaneous coronary intervention （PCI） in elderly patients with non-ST-segment elevation acute coronary syndrome（ACS）. Methods 58 Elderly patients with non-ST-segment elevation ACS were treated by PCI within 48 hours. The major adverse cardiac events （MACE） in patients after PCI were observed. Results Couple or triple lesions were showed in 74.14% of patients by coronary angiography, most of which were type B or type C lesions 76 stenotic coronary artery were intervened in 58 patients. There were 87 targeted lesions in all. 96 stems were implanted. The procedures were performed successfully in 56 patients （success ratio 96.55% ）. There were no myocardial infarction and death in 6-14 months follow-up for 55 patients. 6 patients suffered recurrent angina during the follow-up. 5 patients received repeat coronary angiography. 2 patients suffered restenosis in the segment of stents and 3 patients suffered new coronary stenosis. Re-PCI was performed in lesions with more than 75 percent stenosis for 4 patients. Condttsion Most of elderly patients have complex and diffuse coronary lesions. The early PCI for elderly patients with non-ST-segment ACS is safe and effective. The early PCI has favorable long-term results and low MACE rate.