70岁以上冠心病患者支架植入术治疗效果及安全性评估

Evaluation therapeutic effectivity and safety of stent implantation in patients with coronary heart disease aged 70 years or over

目的评价70岁以上冠心病患者冠状动脉内支架植入后的治疗效果及其安全性。方法回顾性比较95例70岁以上和321例70岁以下冠心病患者冠状动脉内支架植入术后，两组患者的治疗效果和心绞痛复发、再狭窄，急性心肌梗死、死亡、靶血管血运重建等主要心脏不良事件的发生情况。结果（1）两组患者病变支数（X^2=0．52，0．47，0．21，P均〉0．05）及病变累及部位（X^2=1．02，1．23，1．17，P均〉0．05）构成比较，差别无统计学意义；（2）两组患者再狭窄发生率比较，差别无统计学意义（X^2=1．03，P〉0．05）；（3）两组患者急性心肌梗死发生率比较，差异无统计学意义（X^2=0．67，P〉0．05）。70岁以上组远期主要心脏不良事件（MACE）、心绞痛复发、靶血管血运重建、死亡分别为13．4％、6．0％、3．7％、2．4％，高于70岁以下组的8．4％、4．4％、1．5％、0．7％（2／321）（X^2分别为3．21、2．98、4．12、3．65，P均〈0．01）。结论70岁以上和70岁以下冠心病两组患者冠状动脉内支架植入术治疗效果相近，主要心血管病事件中除急性心肌梗死发生率外，差异有统计学意义。70岁以上冠心病患者冠状动脉内植入支架是安全有效的，主要心血管病事件比70岁以下冠心病患者发生率要高。

Objective To evaluate the therapeutic effectivity and safety of stent implantation in patients with coronary heart disease aged 70 years or over. Methods All the patients with coronary heart disease after stent implantation were divided into two groups：≥70 years group （95 cases） and 70 years group （321 cases）. The therapeutic effectivity and major adverse cardiac events （MACE）, including recurrent angina, restenosis, acute myocardial infarction, death and revascularization, were compared retrospectively. Results The lesion number and lesion region of coronary artery between the two groups showed no differences （P〉0.05）. There were no significant differences in restenosis rate and frequency of acute myocardial infarction. The long term MACE, the rates of recurrent angina, revascularization and death were higher in ≥70 years group than in 〈70 years group （13.4% vs 8.4%, 6. 0% vs 4.4%, 3.7% vs 1.5%, 2.4% vs 0.7%,X^2=3.21,2.98,4.12,3.65 respectively, all P〈0.01）. Conclusions The therapeutic effectivity and safety of stent implantation in coronary heart disease patients over 70 years old are similar to the patients under 70 years old. The rate of MACE is higher in ≥ 70 years group than in 〈70 years group except for the frequency acute myocardial infarction.