老年急性心肌梗死患者急诊PCI临床预后分析

The prognosis analysis of primary percutaneous coronary intervention in patients with acute myocardial infarction in elderly patients

目的评价年龄对急性心肌梗死急诊经皮冠状动脉血管成形术(PCI)的影响以及冠状动脉内支架植入术是否改善老年急性心肌梗死患者的临床预后。方法接受急诊PCI治疗的急性心肌梗死患者中>75岁的52例为高龄组,60岁以下64例为低龄组。比较2组冠状动脉病变特点及临床预后。结果与低龄组比较,高龄组多合并高血压病、糖尿病、高脂血症;心力衰竭发生率高于低龄组(P<0.05),入院至梗死相关动脉开通时间长于低龄组(P<0.05),2组梗死相关动脉急诊PCI成功率差异无统计学意义(P>0.05),术中主动脉内气囊反搏术应用比例,高龄组多于低龄组(P<0.05),高龄组随访期间主要不良心血管事件发生率高于低龄组(P<0.05)。结论老年急性心肌梗死患者行急诊PCI可以改善其临床预后。

Objective To observe and assess the safety and efficacy .of one-year outcome of primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods All the patients with AMI（ 〈 12h） underwent primary PCI and were divided into the elder group （ ≥75 years, n = 52）and the younger group （ 〈 60 years, n = 64）. The basic characteristics, immediate success rate and major adverse cardiac events （MACE） including recurrent angina, myocardial infarction,heart failure and sudden cardiac death during follow-up were analyzed for both groups. Results The ratio of patients with heart failure and multi-vessel lesions was significantly higher in the eider group than that in the younger group （25.0% vs 7.8% and 63.5% vs 25.0% ,respectively, P 〈 0.05 ）. The time from adimission to revacularization of infarction related artery （IRA） was significantly longer in the elder group than that in the younger group [ （36 ± 19）min vs （20 ± 14）min, P 〈 0.05 ]. The immediate success rate of primary PCI was 96.2% and 100% in elder group and younger group respectively. During the follow-up period, 16 cases of recurrent angina,6 cases of heart failure and I case of cardiac death were observed in the elder group, however, in the younger group only 6 cases of recurrent angina, no MI and no sudden cardiac death were observed. The MACE ratio was 46.0% and 14.1% in the eider group and younger group respectively（ P 〈 0.05 ）. Conclusion The primary percutaneous coronary interventionean improve the clinical prognosis in elderly patients with acute myocardial infarction.