老年冠心病患者临床特征及PCI术后远期疗效观察

Clinical characteristics and long-term outcomes of stents implantation for elderly patients with coronary artery disease

目的评价老年冠心病患者临床特征及经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后远期安全性及有效性。方法随机选取2007年1月-2009年1月在解放军总医院心血管内科行冠状动脉支架置入患者632例,将患者分为老年组(≥65岁)和非老年组(<65岁),于2012年3月采用电话随访、门诊检查、冠脉造影等随访方式观察患者冠状动脉支架置入后远期不良心血管事件(major adverse cardiac events,MACE)发生情况。结果老年组与非老年组在女性(24.5%vs 16.8%,P=0.02)、高血压(72.4%vs 59.5%,P=0.001)、吸烟(27.2%vs 53.6%,P=0.001)比例上的差异有统计学意义;PCI术前冠脉造影特征老年组三支病变比例高(44.4%vs 37.3%,P=0.08);两组MACE发生率差异无统计学意义(12.8%vs 9.1%,P=0.15),其他不良事件全因死亡率差异有统计学意义(5.5%vs 1.3%,P=0.004);冠脉造影三支病变中,老年组与非老年组MACE发生率差异无统计学意义(14%vs 8.6%,P=0.23)。结论老年冠心病患者应当积极控制血压,加强老年女性患者冠心病的筛查。老年冠心病患者冠状动脉支架置入术后远期是安全、有效的。

Objective To evaluate the clinical characteristics and the long-term outcomes of elderly patients with coronary artery disease who underwent stents implantation. Methods Clinical data about 632 patients who underwent stents implantation in the department of cardiology of Chinese PLA General Hospital from January 2007 to January 2009 were analyzed. The patients were divided into two groups according to age： more than 65 years old group and less than 65 years old group. The major adverse cardiac events （MACE） of patients were observed by telephone follow-up, interview at clinic or coronary angiography in March 2012. Results There were statistically significant differences in the proportion between 〈 65 years old group and ≥ 65 years old group on hypertension （72.4% vs 59.5%, P=0.001）, female （24.5% vs 16.8%, P=0.02） and smoking （27.2% vs 53.6%, P=0.001）. There was no significant difference of MACE between the two groups （12.8% vs 9.1%, P=0.15）. However, there was significant difference of all-cause mortality between the two groups （5.5% vs 1.3%, P=0.004）. In the three lesions of the coronary angiography, there showed no difference of MACE between the two groups of patients with multi-vessel coronary disease （14.0% vs 8.6%, P=0.23）. Condusion The study indicates that the elder patients should control blood pressure actively and the hospital should strengthen screening on female elder patients. It is safe and effective of elderly patients with coronary artery disease to undergo stents implantation on long-term.