老年人急性冠脉综合征的介入治疗

The Effect of Percutaneous Coronary Revascularization on Geriatric Acute Coronary Syndrome

目的:评价老年急性冠脉综合征病人(GACS)接受介入治疗的条件、并发症和近远期效果。方法:分析1999年1月至2000年12月住院的GACS病人86例,分为早期介入治疗组26例(30.2%,住院3天内);择期介入治疗组28例(32.6%,住院3天至2周);药物治疗组32例(37.2%,C组)。比较3组病人的下列参数:年龄、病史、病重程度I、ABP使用率、介入并发症、住院并发症、病死率、住院时间、随访资料(包括再住院率、病死率、介入治疗和搭桥率)。结果:3组病人的年龄和病史基本相同(P>0.05)。介入治疗组的病重程度、IABP使用率明显大于药物治疗组(P<0.05);住院病死率、住院时间、再住院率、随访病死率、随访介入治疗和搭桥率明显低于药物治疗组(P<0.05)。早期介入治疗组的病重程度和1ABP使用率明显大于择期介入治疗组(P<0.05),但两组的操作并发症、住院并发症和病死率无差别(P>0.05)。结论:①介入治疗能明显降低老年危重GACS病人的住院病死率和并发症,缩短住院时间,改善随访结果;②早期介入治疗是处理GACS危重症的有效方法;③提高GACS危重病人的介入治疗率是改善其整体预后的重要措施。

Objective： The purpose of the study is to evaluate the using indication, complication, immediate and long-term effect of percutaneous coronary revascularization （PCR） in geriatric patients with acute coronary syndrome （GACS）. Methods： Consecutive 86 GACS patients were admitted from Jan. of 1999 to Dec. of 2000. They were divided into three groups of ① early PCR group （PCR was conducted within 3 days after admission, 26 cases, 30. 2%） ; ② elective PCR group （PCR was completed in 3 days to 2 weeks after admission, 28 cases, 32. 6%）; ③ medication group （32 cases, 37. 2%）. Following parameters were compared between 3 groups： age, history, sickness degree, IABP rate, PCR complication, total complication, mortality, hospital time, fellow-up data including readmission rate, fellow-up mortality, re-CABG or PCI rate. Results. The age and history were comparable among 3 groups （P〉0. 05）. The sickness degree and IABP rate in two PCR groups were obviously higher than those in the medication group （P〈0. 05）, but the word mortality, hospitalization time, readmission rate, follow-up mortality, re-CABG or PCR rate were significantly lower than those in medication group （P〈0. 05）. However, the procedure complication, total complication and mortality were similar between two PCR groups. Conclusions. ① PCR could significantly decrease the hospitalization mortality and complication, shorten hospitalization time, and improve follow-up results in GACS patients; ② Early PCR is an effective method to treat high risk GACS; ③ Expending PCR indications with caution in GACS could improve their long-term prognosis.