高龄冠状动脉性心脏病患者经皮冠状动脉介入治疗的临床特点及预后

Clinical feature and outcomes of advanced elderly patients with coronary heart disease undergoing percutaneous coronary intervention

目的观察≥75岁高龄冠状动脉性心脏病患者经皮冠状动脉介入治疗(PCI)的临床特点及其预后。方法 回顾性分析2005年6月—2007年6月间所有于上海交通大学附属胸科医院行PCI的老年患者,分为高龄组(年龄≥75岁,115例)和老年组(年龄≥60岁且<75岁,294例),观察高龄组患者行PCI的临床特点及其住院期间和远期的预后。结果 高龄组的平均年龄为(78.1±3.7)岁,显著高于老年组的(68.0±4.3)岁。平均随访时间为(964±254)d。与老年组相比,高龄组的糖尿病、高血压、高血脂的构成比无明显增加(P值均>0.05),脑卒中、陈旧性心肌梗死、心力衰竭的构成比显著增加(P值均<0.05)。高龄组在住院期间及远期的主要不良心脏事件、死亡和心源性死亡的发生率均显著高于老年组(P值均<0.05)。多因素分析提示,左心室射血分数(LVEF)≤0.40、多支血管病变及急性冠状动脉综合征是影响预后的独立因素,而年龄≥75岁不是独立危险因素。结论 尽管高龄冠状动脉性心脏病患者的一般情况较差,远期临床预后较差,然而年龄≥75岁并不是影响预后的独立因素,LVEF低和急性冠状动脉综合征才是导致临床预后较差的主要原因。

Objective To investigate clinical feature and outcomes of advanced elderly patients（aged 75 years or over）with coronary heart disease undergoing percutaneous coronary Iintervention（PCI）.Methods Elderly patients who underwent PCI from June,2005 to June,2007 in our hospital were divided into advanced elderly group（≥75 years old,n=115）and elderly group（≥60 and 75 years old,n=294）.A retrospective analysis was conducted to compare the clinical features,in-hospital and long-term outcomes of patients in the two groups.Results The mean age of patients was（78.1±3.7）years in the advanced elderly group and（68.0±4.3）years in the elderly group.The patients were followed up for a mean of（964±254）days.The two groups had similar incidences for diabetes,hypertension and hyperlipidemia.The advanced elderly group had significantly higher incidences for stroke,old myocardial infarction,and heart failure（all P0.05）;besides,they also had significantly higher incidences of in-hospital and long-term major adverse cardiovascular events（MACEs）,death and cardiogenesis death compared with the elderly group（all P0.05）.Multivariables analysis showed that the left ventricle eject fraction（LVEF）≤0.40 and acute coronary syndrome,but not aged ≥75 years,were the independent predictors of long-term outcome.Conclusion Advanced elderly patients have a worse baseline condition and poor long-term outcomes.Low LVEF,multiple vessel diseases and acute coronary syndrome,but not aged ≥75 years,are the independent predictors of long-term outcomes of the patients.