高龄女性冠心病患者冠状动脉造影特点及介入治疗的疗效

Long term clinical effectiveness of percutaneous coronary intervention in female patients with coronary artery disease over 75 years old

目的：探讨高龄女性冠心病患者的冠状动脉造影介入治疗特点及近远期的疗效。方法：在2004年1月~2006年3月行冠状动脉介入治疗的患者中,入选183例女性患者,根据年龄分为高龄女性组（年龄≥75岁,48例）和非高龄女性组（年龄〈75岁,135例）,同时入选同期77例高龄男性组患者作为对照。回顾性分析这些患者的临床及冠状动脉病变特点、即刻手术成功率和近远期主要心脏不良事件。结果：与非高龄女性组相比,高龄女性组表现为更多的危险因素及基础疾病丛集（P〈0.05）,多见冠状动脉多支病变及复杂病变（P〈0.01）,住院期间及远期随访严重心脏不良事件发生率高。与高龄男性组相比,高龄女性也表现为更多的危险因素及基础疾病丛集（P〈0.05）,尽管冠状动脉病变分布及严重程度相似（P〉0.05）,但住院期间及远期随访严重心脏不良事件发生率高（P〈0.05）。高龄女性与高龄男性患者的总病死率差异无统计学意义,在校正了基线特征后,女性患者的危险降低（OR=0.82,95%CI0.675-0.989,P〈0.05）。结论：高龄女性冠心病患者常伴有多种危险因素及基础疾病,冠状动脉病变严重复杂,近远期主要心脏不良事件发生率高,总病死率与高龄男性患者差异无统计学意义。

Objective：To explore long time clinical effectiveness of percutaneous coronary intervention in female patients with coronary artery disease over 75 years old. Method： A total of 183 consecutive female patients with coronary artery lesions who underwent percutaneous coronary intervention during the period from January 2004 to March 2006, were divided into elder group（age≥75 years old） and younger group （age〈75 years old）. Of them, 77 elderly male patients （age≥75 years old）with coronary artery lesions who underwent PCI during the same period were detined as the control group. The basic characteristics,immediate success rate and the incidence of MACE during follow-up were analyzed among the three groups. Result： Compared with the younger female patients, the elderly female patients often have more comorbiditities, risk factors,multivessle lesions and complex lesions. The in-hospital outcomes and long term follow-up revealed that the incidence of MACE were higher in the elder group than those in the younger group. Compared with the elder male patients,the elderly female patients also have more comorbiditities and risk factors; the incidence of MACE of the elder female patients was higher;but mortality was higher in women （8.9%） than in men （3.9%） （P〉0.05）. However, while using Cox proportional hazards analysis to adjust for comotbidities and possible confounders,female sex was associated with a significant reduction in the risks of long-term mortality （hazard ratio 0. 82,95% CI 0. 675-0. 989, P〈0.05 ）. Conchision： The elderly female patients often have more comorbiditities, risk factors, multivessle lesions and complex lesions; The in-hospital outcomes and long term follow-up revealed that the incidence of MACE were higher in the elder female group than those in the other two groups, despite of more high-risk characteristics.