老年急性心肌梗死住院患者临床特点及急诊介入治疗的近期疗效

Efficacy of emergency percutaneous coronary intervention in elderly patients with acute myocardial infarction:clinical analysis of 771 elderly and 566 younger cases

目的评价急诊经皮冠状动脉介入治疗(PCI)对老年急性心肌梗死(AMI)患者住院期间的疗效。方法将沈阳军区总医院心血管中心从1995年12月至2006年6月收治的1337例AMI患者分为老年组(≥60岁,771例)和非老年组(<60岁,566例),于发病24h内行急诊PCI,比较两组患者的临床和冠脉造影特征、PCI成功率及术后并发症发生率。结果老年组有高血压、糖尿病、典型心绞痛等病史患者显著多于非老年组(P<0.05);老年组女性、非ST段抬高型AMI、急性左心衰、心源性休克患者显著多于非老年组(P<0.05);而非老年组吸烟和有高脂血症病史患者显著多于老年组(P<0.05)。老年组3支病变率为63.8%,显著高于非老年组的52.5%(P<0.01)。从发病至球囊扩张时间、PCI即刻成功率、无复流发生率、造影剂用量、术后住院时间在两组均无显著差异(P>0.05);术后心绞痛复发、再次心肌梗死、缺血性靶血管重建及非心脏并发症发生率两组亦无显著差异(P>0.05)。结论急诊介入治疗是老年AMI患者很好的可供选择治疗方法。

Objective To explore the in-hospital efficacy of emergency percutaneous coronary intervention （PCI） in treatment of elderly patients with acute myocardial infarction （AMI）. Methods From December 1995 to June 2006, emergency PCI was performed in 1337 patients with AMI less than 24 h after onset of the disease, including 771 cases in elderly group（age ≥60 years ） and 566 cases in young group （age 〈60 years ）. The clinical and angiographic characteristics, success rate of PCI and rate of complications related to PCI procedure were compared between the two groups. Results There were more patients with hypertension, diabetes mellitus and typical angina pectoris in elderly group than in young group （P〈0.05）, and more patients with non-ST elevated myocardial infarction, acute left heart failure, cardiogenic shock and females in elderly group than in young group （P〈0.05）. The number of triple vessel disease in elderly group was higher than that in young group （63.8 % vs 52.5 %, P〈0.01）. The number of patients with hypercholesterolemia and smoking in young group was higher than that in elderly group （P〈0.05）. There was no significant difference in the time from onset to balloon dilatation, rates of PCI procedure success and no-reflow, dose of contrast-medium, length of hospital stay after PCI and incidence of complications between the two groups （P〉0.05）. Conclusion Emergency PCI is a preferable treatment for elderly patients with AMI.