高龄急性心肌梗死患者经皮冠状动脉介入治疗效果及安全性分析

Efficacy andsafetyof percutaneous coronary interventionin treatment of very oldpatients with acute myocardial infarction

目的：评价高龄急性心肌梗死患者行冠状动脉介入治疗（PCI）的安全性和有效性。方法回顾性地分析西安交通大学医学院第一附属医院近5年来高龄（≥80岁）急性心肌梗死病例78例。其中PCI治疗40例，药物保守治疗38例，对比分析两组患者的基础临床资料、住院期间临床疗效以及PCI术后6个月的随访结果。结果与药物保守治疗组相比，PCI治疗组住院期间心肌梗死症状缓解率明显提高（52.63%vs 75.00%，P＜0.05），心力衰竭发生率明显降低（39.47%vs 15.00%，P＜0.05）。出院后6个月内再次心绞痛（42.86%vs 18.42%）和心肌梗死（22.86%vs 5.26%）的发生率均显著降低（P＜0.05），再次心血管事件和猝死的发生率也有一定下降（25.71%vs 10.52%，P＝0.09）。结论 PCI治疗可以改善高龄急性心肌梗死患者的临床症状和预后，从而进一步提高患者生存质量。由此可见，高龄急性心肌梗死患者的 PCI治疗是安全可行和有效的。

ObjectiveTo estimate the efficacy and safety of percutaneous coronary intervention （PCI） on thevery old patients with acute myocardial infarction （AMI）.Methods A retrospective analysis was carried out on 78very old patients （≥80 years old） withAMI in our hospital in recent 5 years. Ofthem, 40 patientsunderwentPCI therapy and 38 patients receivedconservative drug treatment. The general clinical data,andclinical therapy efficacy during hospitalization andin6 monthsoffollow-up werecollected and analyzed in 2 groups. Results Compared with the conservative drug treatment group, the relief rate of myocardial infarction symptoms was significantly increased （52.63%vs 75.00%,P〈0.05） and the incidence of heart failure during hospitalization was significantly decreased （39.47%vs 15.00%,P〈0.05） in PCI group. Moreover, the incidence of recurrence angina（42.86%vs 18.42%）and myocardial infarction （22.86%vs 5.26%） in 6 months after discharge were significantly decreased （P〈0.05）, and cardiovascular events and sudden death were also reduced inPCI group compared with conservative drug treatment group （25.71%vs 10.52%,P=0.09）.Conclusion PCI therapygreatlyimproves the clinical symptoms and prognosis, and the quality of life inthevery old patients withAMI. Therefore, PCI is a safe and effective treatment for thevery old patients withAMI.