不同年龄冠心病患者经桡动脉介入治疗的安全性和有效性对比分析

Comparison of outcomes after transradial intervention in patients of different age groups

目的分析不同年龄组冠心病患者经桡动脉介入治疗（TRI）住院期间安全性和有效性及不良事件的预测因素。方法研究对象为我院2004年5月至2009年5月接受TRI的16293例冠心病患者，分析不同年龄组，中青年（〈65岁）、老年（65～79岁）、老老年（≥80岁）患者住院期间临床后果，多因素分析住院期间主要不良心脏事件（包括死亡、心肌梗死和靶血管血运重建）的影响因素。结果中青年、老年、老老年组造影成功率分别为97．5％，97．4％，98．1％（P〉0．05），而操作并发症随年龄增加而增加（0．8％、1．2％、4．O％，P〈0．01）。中青年、老年、老老年组之间住院期间主要不良心脏事件发生率（分别为1．3％，2．2％，7．5％，P〈0．01）和病死率（0．1％、0．3％、2．9％，P〈0．01）随年龄增加而增加，植入药物涂层支架比例逐渐下降（92．0％、89．6％、57．8％，P〈0．01）。多因素分析表明住院期间主要不良心脏事件的独立预测因素[OR（95％可信区间）]为年龄≥80岁[6．26（3．33～11．74）；P〈0．01]，既往心肌梗死[2．19（1．66～2．88）；P〈0．01]、左主干病变[2．02（1．04～3．91）；P=0．04]、年龄65～79岁[1．83（1．37～2．43）；P〈0．01]、支架数[1．31（1．15～1．50）；P〈0．01]、支架总长度[1．01（1．00～1．02）；P=0．03]、植入药物涂层支架[0．59（0．39～0．89）；P=0．01]。结论中青年、老年患者经桡动脉介入治疗住院期间具有良好的临床疗效，而年龄／〉80岁患者住院期间不良事件危险度明显增加。

Objective To compare the in-hospital clinical outcome of patients with coronary artery disease in different age groups [ 〈 65 years （younger）, 60 to 79 years （older）, and ≥ 80 years （octogenarians） ] underwent transradial intervention （TRI） so asto analyze the predictors of adverse events. Method From May 2004 to May 2009, a total of 16 293 patients underwent transradial intervention at our institution. The in- hospital outcome for patients in different age groups after TRI was investigated. Multivariable logistic regression analysis was performed to determinate the predictors of in-hospital major adverse cardiac events（MACE） （composed of death, myocardial infarction or target vessel revascularization）. Results Angiographic success rates were not different （97.5%, 97.4%, 98. 1%, P 〉 0. 05） between 3 groups. However, the rates of procedureal complications became progressively higher with age group （O. 8 %, 1.2 % ,4.0%, P 〈 0. 01 ）. In-hospital MACE （ 1.3 % vs 2. 2% vs 7. 5 %, P 〈 0. 01 ） and mortality （0. 1% vs 0. 3% vs 2.9%, P 〈0. 01 ） increased incrementally with age group. Aad it was associated with a significant decrement of DES （ 92. 0% , 89. 6% , 57.3% , P 〈 0. 01 ） . The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events ： age≥80 （ OR6.26, 95%CI： 3.33 to 11.74; P〈0.01）, prior myocardial infarction（OR 2. 19, 95%CI：1.66 to 2. 88; P〈 0.01）, left main lesion（OR 2.02, 95% CI： 1.04 to 3.91; P =0.04）, age of 65 to 79（OR 1.83, 95% CI： 1.37 to 2. 43 ; P 〈 0. 01 ）, number of implanted stents （ OR 1.31, 95% CI： 1.15 to 1.50 ; P 〈 0. 01 ）, total stented length（ OR 1.01, 95% CI： 1.01 to 1.02 ; P = 0. 03）, and use of DES （ OR 0.59, 95% CI： 0.39 to 0. 89 ; P = 0. 01 ）. Conclusions The younger and older patients undergoing TRI have a more favorable in-hospital outcome. However the octogenarians has a substantially higher risk of in-hospital MACE.