老年冠心病患者介入治疗术后的预后因素分析

The prognostic factors after percutaneous coronary intervention in elderly patients with coronary disease

目的 探讨影响老年冠心病患者介入治疗后的预后因素. 方法 1981例经皮介入治疗后的冠心病患者被分为老年组（≥65岁）801例和对照组（非老年组,＜65岁）1180例.术后随访12～84个月（平均36个月）. 结果 老年组全因死亡率明显高于对照组（5.4％和2.3％,P＜0.01）；老年组的主要心血管不良事件（MACE）明显高于对照组（18.9％和3.7％,P＜0.01）.影响介入治疗后死亡的因素为年龄65岁（OR=1.05,95％ CI=1.02～1.10,P=0.014）,左主干病变（OR=4.78,95％ CI=2.36～17.22,P=0.027）,冠状动脉3支病变（OR=5.68,95％ CI=3.17～15.32,P=0.018）,合并糖尿病（OR=6.24,95％CI=2.11～16.36,P=0.001）；影响介入治疗后主要心血管不良事件的因素为年龄65岁（OR=2.06,95％CI=2.23～4.32,P=0.007）,左主干病变（OR=3.64,95％CI=1.86～15.34,P=0.001）,冠状动脉3支病变（OR=4.35,95％CI=2.54～13.82,P=0.017）,合并糖尿病（OR=5.35,95％ CI=1.77～14.51,P=0.001）.性别和高血压不是影响总死亡率和主要心血管不良事件的因素. 结论 年龄、糖尿病、左主干病变、冠状动脉3支病变是影响老年冠心病患者介入治疗预后的主要因素,而性别和高血压对预后影响不明显.

Objective To investigate the prognosis influencing factors after percutaneous coronary intervention in elderly patients with coronary artery disease（CAD）.Methods 1981patients with CAD who received percutaneous coronary intervention（PCI）were divided into two groups：the elderly（aged ≥65 years,n=801）group and control group（aged 〈65 years,n=1180）.The follow-up time was 12-84 months（average of 36 months）.Results The total mortality rate （5.4% versus 2.3%）and major adverse cardiac vessel events（MACE）in the elderly group were higher than those in control group（18.9% versus 3.7%,P〈0.01）.The risk factors of total mortality after PCI were age（≥65 years）（OR=1.05,95 %CI=1.02-1.10,P=0.014）,left main trunk pathology（OR =4.78,95%CI=2.36 17.22,P =0.027）,triple coronary artery pathology（OR =5.68,95%CI=3.17-15.32,P=0.018）,concomitant diabetes mellitus（DM）（OR=6.24,95%CI=2.11-16.36,P=0.001）.The risk factors of MACE after PCI were age（≥65 years）（OR=2.06,95%CI=2.23-4.32,P=0.007）,left main trunk pathology（OR=3.64,95%CI =1.86-15.34,P=0.001）,triple coronary artery disease（OR=4.35,95%CI=2.54 13.82,P=0.017）,concomitant DM（OR=5.35,95%CI=1.77-14.51,P=0.001）.However,sex and hypertension（OR =1.09,95%CI=0.35-1.89,P=0.062）was not risk factors of total mortality and MACE.Conclusions The risk factors of total mortality and MACE in elderly patients with CAD receiving PCI are aging,DM,left main trunk pathology and triple coronary artery disease except for hypertension and sex.