70岁及以上患者冠状动脉无保护左主干病变支架置入术后的随访研究

The in-hospital and long-term follow-up of unprotected left main coronary artery stenting in patients aged 70 years and older

目的观察年龄70岁及以上患者无保护左主干病变经皮冠状动脉介入治疗（PCI）预后的近期和长期临床随访结果。方法回顾性分析100例无保护左主干病变行药物洗脱支架置人患者临床资料，比较年龄70～90岁组（52例）和37～69岁组（48例）的病死率、心肌梗死、再次血运重建及其综合终点。结果两组危险因素、血管病变及置入支架等基线资料比较，差异无统计学意义（均P〉0．05）。70～90岁组和37～69岁组手术成功率分别为96．2％（50例）与97．9％（47例），差异无统计学意义（χ2=1．75，P〉0．05），住院病死率分别为3．8％（2例）与2．1％（1例），差异无统计学意义（χ2=0．27，P〉0．05）。两组平均随访时间分别为（22．0±12．5）个月与（23．0±11．7）个月，差异无统计学意义（t=-0．78，P〉0．05）。随访期间70～90岁与37～69岁组病死率、心肌梗死、再次PCI分别为3．8％（2例）与2．1％（1例）、7．7％（4例）与4．2％（2例）和13．5％（7例）与12．5％（6例），差异无统计学意义（χ2值分别为2．51、0．55、0．02，均P〉0．05），死亡、心肌梗死及再次血运重建综合终点分别为30．8％（16例）与18．8％（9例），差异无统计学意义（χ2=1．92，P〉0．05）。结论70岁及以上患者冠状动脉无保护左主干病变药物洗脱支架置入手术成功率高，长期随访安全有效。

Objective To observe the in-hospital and long-term results in patients with drug- eluting stenting age≥70 years with unprotected left main （UML） coronary artery disease. Methods In this retrospective study, 100 patients with UML disease were enrolled. Death, myocardial infarction, repeated revascularization and composite end points during follow-up were compared between groups aged ≥70 years and control aged 〈70 years. Results There was no remarkable distinction between the two groups in cardiovascular risk factors, anatomic findings of coronary artery disease and stent variables. No significant differences were found between the two groups in procedure success rate[96.2% （50 cases） vs. 97.9% （47 cases）χ2 = 1.75, P〉0.05] and in-hospital mortality [3.8 % （2 cases） vs. 2.1 % （ 1 case） , χ2 = 0.27, P 〉 0.05]. Patients were clinically followed for an average time of 22.0 months in the elderly group and 23.0 months in the control group （t= -0.78, P %0.05）. There were no significant differences in death[3.9 % （2 cases） vs. 2.1% （1 case）,Z2= 2.51, P〉0. 05], myocardial infarction[7.7%（4 cases） vs. 4.2%（2 cases） χ2 =0.55, P〉0. 053, repeated revascularization [13.5% （7 cases） vs. 12.5%（6 cases） χ2 =0.02, P〉0.05]and composite endpoints of death, myocardial infarction and repeated revascularization[30.7o/00 （16 cases）vs. 18.8%（9 cases）, χ2 =1.92, P〉0.05] between the elderly group and the control group. Conclusions The procedure success rate and in-hospital mortality of drug-eluting stent implantation in elderly patients aged%70 years old with unprotected left main coronary artery are comparable to group aged%70 years. The main endpoints including death, myocardial infarction and repeated revascularization are favorable at about 2 years clinical follow up. It is safe and efficacious to implant drug-eluting stent in patients aged ≥70 years old with unprotected left main coronary artery.