老年冠状动脉慢性完全闭塞病变的临床及影像学特点

Clinical and imaging characteristics of chronic total occlusion of coronary artery in old patients

目的回顾性分析老年冠状动脉慢性完全闭塞(CTO)的冠心病患者的临床和影像学资料,总结老年CTO病变的临床和影像学特点。方法入选1989年6月至2005年12月诊断冠心病的患者。入院后行常规实验室生化检查及X线胸片、心脏超声等临床辅助检查,并行冠脉造影及左室造影检查。分组标准:≥60岁CTO患者作为老年组,同期<60岁CTO患者作为对照组。结果经冠脉造影证实有一支以上的CTO病变者共1716例。其中老年组971例,对照组745例。本组老年CTO患者中女性患者占27.4%,而对照组为9.1%;老年CTO患者的吸烟(57.2%)和患高血压比例(61.3%)均高于对照组(分别为26.7%和48.5%),P<0.05。老年组有陈旧心肌梗死病史的比例(46.3%)低于对照组(54.5%),P<0.05;而老年组合并心律失常(10.4%)、心力衰竭(27.3%)、脑血管病史(6.4%)的比例均高于对照组(分别为6.8%、18.7%和2.7%),P<0.05。老年组的肾功能水平高于对照组,P<0.05。老年组人均CTO支数(1.44±0.35)高于对照组(1.39±0.98),P<0.05。老年组合并多支病变的比例(83.9%)高于对照组(71.0%),P<0.05。老年患者CTO特征中绝对性(93.9%)、刀切状(37.4%)、长度≥15mm(72.4%)、直径≤2.5mm(13.3%)及桥侧支CTO比例(23.4%)均高于对照组(分别为87.5%、24.4%、36.9%、9.3%和14.9%),P<0.05。结论老年CTO病变患者心、脑、肾等重要脏器功能衰竭的程度较非老年CTO患者高,且老年CTO病变复杂程度高、多支病变比例高,增加了介入治疗的难度。

Objectives To analyze the clinical and imaging data of elderly coronary heart disease patients with chronic total occlusion （CTO） of coronary artery and to summarize the clinical and imaging characteristics of these patients. Methods The data of 1 716 patients with CTO verified by coronary angiography between June 1989 and December 2005 were analyzed retrospectively. Results There were 971 old patients （56.6%） and 745 non-old patients （43.4% ,control）. The female patients accounted for 27.4% in old patients and 9.7% in coltrol group. The rates of smoking （57.2%） and hypertension （61.3%） in the old patients were higher than those in the control group （26.7% and 48.5% respectively, P〈0. 05）. The rate of old myocardial infarction （46.3%） in the old patients was lower than that in the control group （54.4 % ）. However the rates of cardiac arrhythmia （10. 4 % ）, heart failure （27. 3%） and stroke（6.4%） were higher in the old patient group than those in the control group （6.8%, 18.7% and 2. 7% respectively, P〈0. 05）. The mean level of BUN in old patients was higher than that in control group（P〈0. 05）. The mean number of CTO vessels in the old patients（1.44±0.35） was greater than that （1.39±0.98） in the control group（P〈0.05）. The rate of multi-vessel lesions （83.9%） in the old patients was higher than that （71.0%） in the control group（P〈0. 05）. The rates of absolute occlusion（93.9%）, stump missing（37.4%） ,CTO≥15 mm in length （72.4 % ）, CTO≤2.5mm in diameter（ 13.3 % ） and bridging collaterals（23.4 % ） in the old patients were higher than those in control group （87.5%, 24.4%, 36.9%, 9.3% and 14.9% respectively, P〈0.05）. Conclusions There were high rates of old CTO patients with heart, brain and kidney function failure and high rates of complex lesions and multi-vessel lesions in old patients. These clinical and angiographic characteristics of old patients may increase the difficulty of PCI and influence the success rate of PCI procedure to some extent.