老年无保护冠状动脉左主干狭窄特点和介入治疗后随访分析

Analysis of clinical characters of non-protected left main coronary artery stenosis and follow-up results of percutaneous coronary intervention in eldly patients

目的:观察老年无保护冠状动脉左主干病变的临床特征,分析老年无保护冠状动脉左主干病变(ULMCA)介入治疗的临床随访结果。方法:回顾性分析276例老年无保护左主干病变介入治疗患者的临床资料及冠状动脉造影结果,并经随访6～24个月,观察心绞痛复发、非致死性心肌梗死、死亡和再次进行冠脉血运重建术等终点事件的发生情况。结果:①老年患者危险因素中高血压、糖尿病比非老年组多见,而非老年组吸烟、肥胖者高于老年组;②临床资料比较:左主干病变老年组中心绞痛发生率88.6%,心肌梗死发生率为65.7%,明显多于非老年组(P<0.05),同时老年组LVEF较非老年组更低(48.3%vs 60.6%)(P<0.05);③老年患者左主干病变合并多支血管病变为主(91.4%),左冠状动脉主干狭窄多位于左主干远端分叉处(55.7%);④老年ULMCA病变PCI术和CABG术,在住院期间的终点事件中,均无死亡及心肌梗死。随访发现,进行PCI或CABG治疗组的死亡率和心肌梗死发生率显著低于药物治疗组(P<0.05)。但PCI组心绞痛复发率、血运重建率高于CABG组(P<0.05)。结论:老年左冠状动脉主干狭窄发生率略高,多伴发糖尿病、高血压,合并有多支血管病变,病情更严重,PCI治疗更复杂。经过选择的老年ULMCA支架置入术是可行和安全的,并可取得较好近、远期疗效。

Objective：To analyze the of clinical characters of non-protected left main coronary artery stenosis（ULMCA） and clinical follow-up results of Percutaneous coronary intervention（PCI） in eldly patients.Methods：A total of 276 eldly patients of with ULMCA were admitted to the Department of Cardiology in Shangdong Provincial Hospital.The clinical and CAG information were collected and studied.Time of the clinical and angiocardiographic follow-up was about 6～24 months.The major adverse cardiac events including death,MI and revascularization were observed.Results：① The rates of Hypertension and Diabetes mellitus were more in elder group than those in non-elder group,but the rates of Smoking and Obesity were less in elder group than those in non-elder group;② Comparison of clinical data： the rate of angina in elder group was 88.6% and the rate of MI in elder group was 67.5%.There was obvious different between elder group and non-elder group（P〈0.05）.The LVEF in elder group was obviously lower than non-elder group（48.3±10.8% vs 60.6±2.4%）（P〈0.05）;③ The rate of at least two vessel stenosis was 91.4% in elder group.The location of the stenosis was most at far left main bifurcation（55.7%）;④ No significance were concluded about the recent effect among PCI and CABG therapies.At long term,the rate of death and MI was lower in revascularization group than pure drug therapy group.The rate of angina recurrence and vessel revascularization were increased in PCI group than in the CABG group.Conclusion：Stenting for selected patients with ULMCA in eldly patients is feasible and safe and has good short and long term effects.