老年急性冠脉综合征的介入治疗

Percutaneous coronary interventions in elderly patients with acute coronary syndrome

目的探讨65岁以上急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)的临床疗效。方法82例平均年龄(72.5±7.5)岁的老年ACS患者,男58例,女24例,所有患者均行冠脉造影证实病变,根据造影结果对“病变血管”进行经皮冠状动脉成形术和/或支架置入术。结果82例中,79例介入治疗成功,成功率为96.3%;138处靶病变,133处治疗成功,成功率为96.4%。支架完全覆盖靶病变,扩张满意,血管腔残余狭窄<20%,TIMI血流3级达到率96%。病变直径狭窄由89.5%±8.6%减轻至3.2%±8.6%(P<001)。结论老年ACS患者及早、充分、持续地开通“病变血管”,恢复前向血流,可挽救濒临坏死的心肌,挽救生命,防止左心室重构,明显改善老年ACS患者的近期和远期预后。

Objectives To explore the clinical effects of pereutaneous coronary interventions （PCI） on elderly patients with acute coronary syndrome （ACS） who were all more than 65 years old. Methods 82 eldedy patients with ACS including 58 males and 24 females （ mean 72.5 ± 7.5 years）, whose diseases were diagnosed and confirmed by coronaryangiography （CAG）received pereutanous transluminal corenary angioplasty （PCTA）and/or intra-coronary stent implantation according the result of CAG. Results 79 out of 82 cases had a successful PCI, the success rate was 96.3%. 138 ont of 147 targeted lesion vessels had effective treatment, success rate was 96.3%. Stent ovedapped targeted lesion completely and acquired satisfactory dilation effect. The residual stenosis vessels were no more than 20% of all lesion vessels and the incidence of TIMI grade blood stream was 96%. The stenosis degree of lesion vessels had a significant decrease from（89.5± 8.6）% to （3.2±8.6）% （P〈0.01）. Conlusions For eldedy patients with ACS eady, sufficient, persistent lesion vessels dilating and recovering of blood flow not only salvages cardiac muscle border on necrosis, saves lives, prevents left ventricle from remodeling, but also improves their prognosis in the near future and long term future.