直接经皮冠状动脉介入治疗80岁以上急性心肌梗死患者的临床评价

Clinical evaluation of direct percutaneous coronary intervention in patients over 80 years with acute myocardial infarction

目的探讨直接经皮冠状动脉介入（PCI）治疗80岁以上急性心肌梗死（AMI）患者的临床疗效和安全性。方法94例80岁以上AMI患者，入院后直接PCI。观察手术成功率、并发症、住院病死率和主要心脏不良事件，出院前测定左心室射血分数（LVEF）。结果冠状动脉造影示梗死相关血管（IRA）心肌梗死溶栓治疗（TIMI）血流分级0～1级，除2例心源性休克患者术中因室颤死亡，其余病例均成功开通IRA，操作成功率97．9％。术后76例血流TIMI3级，16例TIMI2级。术后6例因左心功能衰竭死亡。26例心功能Killipm级以上者使用主动脉内球囊反搏（IABP）辅助循环，持续反搏时间78～154（98．3＋34．5）h。多支病变者除18例3支病变外均在术后3～7d行非IRA的PCI。住院总病死率8．5％（8／94），KillipIII级以上者病死率30．8％（8／26）。仅3．3％（3／92）发生需输血的出血并发症。住院期间无主要心脏不良事件发生。生存的86例患者出院前测LVEF中位值为43％（26％～62％）。存活者术后30d和180d主要心脏不良事件发生率分别为1．2％和4．6％。结论对于80岁以上老年AMI患者行直接PCI安全可行，且成功率较高。

Objective To assess the clinical efficacy and safety of direct percutaneous coronary intervention （PCI） in patients over 80 years with acute myocardial infarction （AMI）. Methods Direct PCI was performed in 94 patients over 80 years with AMI in our hospital. The operation success rate, complications, mortality, major adverse cardiac event and left ventricular ejection fraction （LVEF） were recorded during hospitalization. Results Coronary angiography showed thrombolysis in myocardial infarction （TIMI） 0-1 grade in infmct-related artery （IRA） before PCI. TIMI of coronary artery was grade 3 in 76 patients and grade 2in 16 patients after PCI. Two patients with cardiogenic shock died from ventricular fibrillation during PCI, and IRA was successfully recanalizated in other 92 patients. The operation success rate of PCI was 97.9%. Six patients died from left heart failure postoperation. Intra-aortic balloon pump was performed to assist circulation in 26 patients with Killip m , and the duration of counterpulsation was 78 to 154（98.3±34.5）h. Patients with muhiple IRAs except 18 patients with 3 IRAs were received non-IRAs PCI 3 to 7 d after the operation. The fatality during hospitalization was 8.5% （8/94） in general, and the mortality of in-patients with heart function no less than Killip m was 30.8%. The rate of bleeding complication needed blood transfusion was 3.3% （3/92）. There was no major adverse cardiac event in survival patients during hospitalization. The rates of major adverse cardiac events at 30 and 180 d were 1.2% and 4.6%. The median LVEF was 43% （26% to 62% ） before discharge. Conclusion Direct PCI is a safe operation with high successful rate for patients over 80 years with AMI.