80岁以上冠心病患者血运重建的临床结果分析

Clinical outcomes of coronary revascularization in octogenarians with coronary artery disease

目的评价年龄≥80岁的高龄冠心病患者血运重建治疗后的近期与远期临床结果 ,探讨远期不良事件的预测因素。方法选择接受冠状动脉血运重建治疗的冠心病患者(≥80岁)63例,记录其人口学资料、临床特征、冠状动脉造影和血运重建情况以及主要不良心脑血管事件(MACCE)。对所有患者进行电话或门诊随访,多因素Cox比例风险回归模型分析远期不良事件的预测因素。结果 85.7%的患者为多支病变。分别有81.0%和19.0%的患者接受PCI和冠状动脉旁路移植术(CABG)治疗,PCI成功率为98.0%,CABG成功率为83.3%,血管重建总成功率为95.2%。院内MACCE发生率为4.8%。中位随访时间为541(444～667)d,随访率为95.2%。总MACCE发生率为14.3%,病死率为11.1%;累积生存率为88.5%,累积无MACCE生存率为83.0%。多因素Cox分析,既往血运重建史、慢性完全闭塞病变以及是否循环支持是总MACCE的独立危险因素。结论年龄≥80岁的高龄冠心病患者接受血运重建治疗安全可行,成功率较高,院内不良事件发生率较低,远期生存率较高。

Objective To evaluate short- and long-term outcomes of coronary revascularization in octogenarians with coronary artery disease and predictors of adverse clinical events. Methods Sixty-three consecutive octogenarians with coronary heart disease undergoing coronary revascularization in this hospital were enrolled. The baseline clinical,angiographic data and major adverse cardiovascular and cerebrovascular events（MACCE） were collected by review of medical records. Follow-up data were collected at the time of scheduled clinical visits or telephone communications. Predictors of adverse clinical events were identified by Cox proportional-hazards model. Results 85. 7% of the patients had multivessel disease. 81. 0% and 19. 0% underwent PCI and CABG respectively,and procedural success rate was 95.2%. The incidence of in-hospital MACCE was 4.8%. Patients successfully discharged were followed up for a median of 541 （444-667） days. Follow up rate was 95.2%. The incidences of long-term MACCE and death were 14.3% and 11.1% ,respectively. The cumulative survival rate was 88.5% ,and cumulative survival rate with- out MACCE was 83.0%. Independent predictors of MACCE were history of revascularization,a chronic totally occluded lesion and circulatory support by multivariate analysis. Conclusion Coronary revascularization for octogenarians was safe and feasible,with high procedural success rate, low adverse event rate and favorable long-term survival rate.