经皮冠状动脉介入治疗对老年冠状动脉慢性完全闭塞所致稳定型心绞痛患者生活质量和心血管事件的影响

Effects of percutaneous coronary intervention on life quality and cardiac events in elderly patients with stable angina caused by chronic coronary total occlusion

目的评价经皮冠状动脉(冠脉)介入治疗对老年冠脉慢性完全闭塞所致稳定型心绞痛患者的生活质量和心血管事件的影响。方法本研究为前瞻性研究。连续入选2015年1月至2018年1月我院心内科住院的因冠脉慢性闭塞所致的老年稳定型心绞痛患者87例,用随机数字表法分为联合治疗组(44例)和对照组(43例),联合治疗组给予冠脉介入治疗并优化心绞痛药物治疗,对照组只给予优化心绞痛药物治疗。治疗并随访6个月,比较治疗前后患者心功能、生活质量(西雅图心绞痛问卷,SAQ评分)和不良心血管事件的情况。结果87例患者中,联合治疗组和对照组患者的年龄、男性比例、既往病史、左心室射血分数、冠脉病变部位和SAQ评分等基线资料比较差异均无统计学意义(均P>0.05)。干预并随访6个月后,联合治疗组和对照组患者的SAQ评分均较基线水平改善(均P<0.05),其中联合治疗组的躯体活动受限情况[(86.3±11.6)分比(76.3±21.3)分]、心绞痛稳定状态[(67.3±24.5)分比(57.3±21.2)分]和心绞痛发作频率[(93.3±4.3)分比(86.4±8.3)分]优于对照组(均P<0.05),而联合治疗组和对照组的不良心血管事件发生率18.2%(8例)比16.3%(7例),差异均无统计学意义(χ^2=0.055,P>0.05)。结论在优化药物治疗的基础上,冠脉介入治疗能改善冠脉慢性闭塞所致老年稳定型心绞痛患者的生活质量,但对短期不良心血管事件的发生率无明显影响。

ObjectiveTo investigate the effects of percutaneous coronary intervention(PCI)on life quality and cardiac events in elderly patients with stable angina owing to chronic coronary total occlusion(CTO). MethodsPatients with stable angina due to CTO hospitalized in Beijing Anzhen Hospital from January 2015 to January 2018 were consecutively recruited in this prospective study, and were randomly divided into the combined treatment group(n=44)and the control group(n=43). Patients in the combined treatment group were treated with PCI and optimal medical therapy, and those in the control group were treated with optimal medical therapy alone.Patients followed up for 6 months after treatment.Cardiac function, life quality(Seattle angina questionnaire, SAQ)and adverse cardiovascular events were compared before and after treatment. ResultsA total of 87 patients were involved, with a mean age of (69.5±7.2 )years.Basic characteristics, including age, sex ratio, previous history, left ventricular ejection fraction, coronary artery lesions and SAQ scores, were similar between the groups(P>0.05). After a 6 month post-treatment follow-up, SAQ scores improved in all patients, compared with those before treatment(P<0.05). Moreover, patients in the combined treatment group had higher SAQ scores on physical limitation(86.3±11.6 vs.76.3±21.3), angina stability(67.3±24.5 vs.57.3±21.2)and angina frequency(93.3±4.3 vs.86.4±8.3)than those in the control group(P<0.05). There was no significant difference in major adverse cardiovascular event rate between the groups[18.2%(8 cases) vs.16.3%(7 cases), χ^2=0.055, P>0.05]. ConclusionsCombined with optimal medical therapy, PCI can improve the life quality in elderly patients with stable angina due to CTO, but has no significant influence on the short-term major adverse cardiovascular event rate.