高龄急性心肌梗死患者经皮冠状动脉介入治疗的临床分析

Analysis of clinical risk factors in elderly patients with acute myocardialinfarction undergoing percutaneous coronary intervention

目的探讨经皮冠状动脉介入治疗(PCI)高龄急性心肌梗死(AMI)患者临床特点、影响预后的相关因素。方法将AMI患者176例分为高龄组(≥75岁,74例)和非高龄组(<75岁,102例);对比分析病史、左室舒张末内径(LVDD)和左室射血分数(LVEF),检测PCI术前血清肌酸激酶同工酶(CK-MB)、血清肌钙蛋白I(cTnI)、高敏C-反应蛋白(hsCRP)和血肌酐(Cr),分析两组患者的性别、危险因素、并发症等;观察PCI特点及术后主要不良心血管事件(MACE)发生情况。结果与非高龄组比较,高龄组合并高血压、2型糖尿病、缺血性脑卒中及慢性阻塞性肺疾病的发生率明显增高,LVDD增大,LVEF降低,CK-MB、hsCRP、cTnI、Cr水平显著增高,病变血管数和复杂病变数及术后并发症均明显增多,且住院时间长,在住院及随访12个月期间MACE发生率明显增高。结论高龄AMI患者合并多种慢性疾病,冠状动脉病变复杂,PCI并发症多,预后较差。

Objective To study the influencing prognosis factors and clinical characteristics of acute myocardial infarction（AMI） in elderly patients undergoing percutaneous coronary intervention.Methods 176 patients hospitalized for AMI were registered,including 74 cases whose ages ≥75 years and 102 cases whose ages 75 years.Serum creatine phosphokinase isoenzyme（CK-MB）,troponin I（cTnI）,high sensitive C reactive protein（hsCRP） and creatinine（Cr） levels were measured before PCI.Left ventricular end diastolic diameter（LVDD） and left venricular ejection function（LVEF） were assessed before PCI.Features of sex,risk factors,complication and prognosis of two groups were compared and studied.The characteristics of coronary artery and major adverse cardiovascular events（MACEs） occurred in hospital and 12 months after discharge were registered.Results Compared with non-elderly group,the patients in elderly group significantly had more accompanied events such as hypertension,type 2 diabetes,cerebral arterial thrombosis,chronic obstructive pulmonary disease,higher LVDD and lower LVEF,higher level of CK-MB,hsCRP,cTnI and Cr.The numbers of the diseased vessels and stents,the hospitalization time and the incidence of complex lesions and complications during PCI were significantly higher in elderly group than those in non-elderly group.MACEs during hospitalization and 12 months follow-up were more in elderly group than those in non-elderly group.Conclusion PCI in elderly patients with AMI has more complications,complex coronary artery lesions and poorer prognosis.