85岁及以上老年冠心病患者经皮冠状动脉支架治疗的临床观察

In-hospital and long term clinical outcomes of patients aged 85 years and over with coronary heart disease undergoing stent-based percutaneous coronary intervention

目的探讨85～94岁冠心病患者经皮冠状动脉支架治疗的疗效和预后。方法回顾性分析90例85岁以上冠心病患者经皮冠状动脉支架治疗的临床和造影特点、住院期间和长期疗效。结果90例中，21例应用金属裸支架（BMs），69例应用药物洗脱支架（DES）。三支病变41例，2支病变21例，单支病变28例。手术成功率为94．4％，术前与术后TIMI-3级血流比例分别为72．2％和94．4％。手术相关并发症为15．6％，主要为冠脉夹层（11．1％）。住院期间主要心血管不良事件（MACE）为7．8％，其中DES组住院期间MACE为5．8％，BMS组为14．3％。DES组出现2例严重出血。86例患者随访1年时，总的MACE为4．6％，其中DES组为6．0％，BMS组没有任何MACE。DES组出现1例脑卒中和1例严重出血。47例患者随访2年时，总的MACE为14．9％，其中DES组MAcE为19．4％，BMS组无任何MACE。DES组1例发生严重出血，BMS组1例发生脑卒中。多因素C0x回归分析表明，肌酐水平和高血压是影响长期预后的重要因素。结论85岁以上冠心病患者经皮冠状动脉支架治疗手术成功率较高，住院期间和长期的MACE事件发生率较低，并存高血压和严重肾功能不全的患者MACE的发生率相对较高。

Objective To evaluate the in-hospital and long term clinical outcomes of patients aged 85 years and over with coronary heart disease undergoing stent-based percutaneous coronary intervention（PCI）. Methods A total of 90 patients aged 85 years and over with coronary heart disease （CAD） undergoing the stenting were enrolled in this study. The data of baseline characteristics, procedural details, in-hospital and 1 year clinical follow-up outcome including major adverse cardiac event（MACE）, stroke and other major bleeding were collected and analyzed. Results Of the 90 patients, 21（23.3%0） underwent bare metal stent （BMS） implantation; 69 （76. 7%）, drug eluting stent （DES）implantation; A total of 41（45.5%） had 3 vessel diseases, 21（23.3%） had double vessel diseases and 28（31.1%） had single vessel disease. The procedure success rate was 94. 4 % with TIMI-3 coronary flow of post-PCI in 94.4 % vessels while TIMI-3 coronary flow of pre- PCI only in 72.2 % vessels. Procedure-related complications occurred in 15.6 % of the patients with 11.1% incidence of dissection. In-hospital MACE was 7.8%. Two cardiac deaths and 2 myocardial infarctions （MI） occurred accounting for the in-hospital MACE of 5.8% in DES group, while there were 2 cardiac deaths and 1 MI accounting for the in-hospital MACE of 14. 3% in BMS group. Two major bleeding occurred in DES group. One year clinical follow-up incidence of MACE was 4.6% （4/ 86）, in DES group was 6.0%, while there was no MACE in BMS group. One stroke and 1 major bleeding occurred in DES group. Two years clinical follow-up incidence of MACE was 14.9 % （7/47）, in DES group was 19.4% while there was no MACE in BMS group. One major bleeding occurred in DES group and 1 stroke occurred in BMS group. Multiple factors COX regression analysis showed that the creatinine level [OR： 1.02 （1.01-1.03）, P = 0. 004] and hypertension[OR： 3.20 （1.00-10.22）, P=0. 04] were major factors affecting the long-term MACE. Conclusions Percutaneous coronary stenting in CAD patients aged 85 years and over has high procedure success rate and low in-hospital mortality and low MACE during long-term follow up. The very elderly patients who have severe renal disease and hypertension may have relatively high incidence of MACE.