75岁以上老年冠心病患者介入治疗近期疗效分析

The In-Hospital Outcomes of Percutaneous Coronary Intervention in Octogenarians With Coronary Heart Disease

目的:比较75岁以上老年冠心病患者急诊和择期经皮冠状动脉(冠脉)介入治疗术(PCI)的近期安全性和有效性,初步探讨75岁以上老年冠心病患者介入治疗策略。方法:回顾性分析145例75岁以上老年冠心病患者〔急性心肌梗死(AMI)24小时内行急诊PCI者为AMI<24h组27例;AMI后超过24小时行择期PCI、稳定性心绞痛或不稳定性心绞痛行择期PCI者为对照组118例〕的临床基线特征、冠脉病变特点、PCI资料和住院期间事件。用Logistic回归分析75岁以上老年冠心病患者接受PCI治疗的安全性和有效性主要影响因素。结果:AMI<24h组与对照组相比,冠心病病史、陈旧性心肌梗死、合并周围血管疾病的比例降低(29.6%vs75.4%,P=0.000;7.4%vs22.0%,P=0.032;25.9%vs50.0%,P=0.023);明确血栓病变增加(22.5%vs3.2%,P=0.000);PCI治疗的平均靶血管支数少(1.1±0.4vs1.4±0.5;P=0.038);预扩张压力较低(11.9±3.1vs13.4±3.2P=0.008),预扩张后支架置入术比例高(93.3%vs77.3%,P=0.014);主要出血并发症增加(14.8%vs4.2%,P=0.042);心因性死亡率增高(7.4%vs0.0%,P=0.004);血小板膜糖蛋白受体Ⅱb/Ⅲa拮抗剂的使用率升高(63.0%vs22.9%,P=0.000),差异均有统计学意义。结论:75岁以上老年冠心病患者AMI急诊行PCI更易发生出血等致死性并发症。但主要心脑血管不良事件的风险并无明显增加。

Objective：To compare the in-hospital outcomes between emergent percutaneous coronary intervention（PCI） and selective PCI performed on the octogenarian patients with coronary heart disease（CAD） and to explore the optimal PCI strategy for the octogena- rian CAD patients. Methods：We retrospectively studied 145 consecutive patients at the age of 75 years or elder who were allocated into 2 groups, acute myocardial infarction （AMI） 〈 24 h group, n = 27, the patients underwent emergent PCI within 24 hours of AMI, and Control group, n = 118, the patients received selective PCI with AMI 〉 24 h or other coronary heart disease. Baseline clinical characters and the in-hospital outcomes were recorded and compared. Logistic regression was performed to analyze the predictors of the in-hospital outcomes. Results ： Compared with Control group, AMI 〈 24 h group had less prevalence of CAD history, old myocardial infarction and peripheral artery disease（ 29. 6% vs. 75.4% , P = 0. 000 ; 7.4% vs. 22.0% , P = 0. 032 ; 25.9% vs. 50. 0%, P = 0. 023 ）. While compared with Control group, AMI 〈 24 h group had the increased thrombotic lesions （ 22.5% vs. 3.2% , P = 0. 000） , the less mean target vessels（ 1. 1 ±0.4 vs. 1.4 ±0. 5 ,P =0. 038） ,the lower pre-dilative pressure（ 13.4 ±3.2 vs. 11.9 ±3.1 ,P =0. 008） but higher pre-dilation rate（93.3% vs. 77.3% ,P =0. 014）. Furthermore,in AMI 〈24 h group,the main bleeding complication increased （ 14. 8% vs. 4. 2%0 , P = 0. 042 ） , which might result from the more application of Gp Ⅱ b/m a receptor inhibitor（ 63.0% vs. 22.9% , P = 0. 000） , and caused the higher mortality（ 7.4% vs. 0. 0% ,P = 0. 004 ）as well. Conclusion：The octogenarian CAD patients with the emergent PCI have more chance to suffer from fatal complications such as main bleeding events. However, the main adverse cardiac and cerebral events do not significantly increase.