经皮冠状动脉介入治疗急性冠脉综合征患者的临床疗效

Curative effect of percutaneous coronary intervention in patients with acute coronary syndrome

目的回顾与总结经皮冠状动脉介入（PCI）治疗急性冠脉综合征（ACS）患者的临床疗效。方法选择2003年10月至2013年10月苏州市立医院北区心血管内科确诊的ACS患者543例。依据入院后手术日期分为急诊PCI组（n=236）和择期PCI组（n=307）。急诊PCI组中,老年组（≥60岁）124例,非老年组（42~59岁）112例;择期PCI组中,老年组（≥60岁）137例,非老年组（42~59岁）170例。收集患者的临床资料,包括穿刺成功率、手术成功率、手术总时间、术后并发症情况及出院后随访1年主要不良心血管事件发生情况等。结果急诊PCI组,老年组与非老年组性别比例、家族史比例、吸烟比例、心梗部位、罪犯血管、血脂、左室射血分数比较无统计学差异（P均〉0.05）。老年组较非老年组,糖尿病、高血压比例增加,总胆固醇降低,差异有统计学意义（P均〈0.05）。择期PCI组,老年组与非老年组性别比例、家族史比例、心梗部位、罪犯血管、血脂、左室射血分数比较,无统计学差异（P均〉0.05）。老年组较非老年组,糖尿病、高血压、吸烟比例增加,差异有统计学意义（P均〈0.05）。急诊PCI组以及择期PCI组,老年组与非老年组穿刺成功率、手术成功率、手术总时间、造影剂量、住院期间再次血运重建以及随访1年再次心梗、再次行血运重建术比较,无统计学差异（P均〉0.05）。急诊PCI组,老年组较非老年组,住院期间死亡比例增加,随访1年死亡、心力衰竭增加,差异有统计学意义（P均〈0.05）。结论 PCI治疗是ACS有效的治疗手段,但其对老年ACS患者远期预后的影响仍需进一步探讨。

Objective To retrospect and summarize the curative effect of percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）.Methods ACS patients （n=543） were chosen from Oct. 2003 to Oct. 2013, and then divided into emergency PCI group （n=236） and selective PCI group （n=307）. Emergency PCI group was divided again into elderly group 1 （aged≥60,n=124） and non-elderly group 1 （aged from 42 to 59, n=112）, and selective PCI group was divided again into elderly group 2 （aged≥60,n=137） and non-elderly group 2 （aged from 42 to 59,n=170）. The clinical data were collected from all patients including puncture success rate, PCI success rate, PCI total time, complications after PCI, and major adverse cardiovascular events （MACE） after 1-year follow-up.Results Between elderly group 1 and non-elderly group 1, the percentages of sex, medical history and smoking, locations of myocardial infarction （MI）, culprit vessels, blood fat and LVEF had no statistical difference （allP〉0.05）. The percentages of patients with diabetes and hypertension increased and total cholesterol （TC） level decreased in elderly group 1 compared with non-elderly group 1 （allP〈0.05）. Between elderly group 2 and non-elderly group 2, the percentages of sex and medical history, locations of MI, culprit vessels, blood fat and LVEF had no statistical difference （allP〉0.05）. The percentages of patients with diabetes, hypertension and smoking cases increased in elderly group 2 compared with non-elderly group 2 （allP〈0.05）. The comparison in puncture success rate, PCI success rate, PCI total time, contrast agent dosage, re-revascularization during hospitalization, and re-MI and revascularization procedure during 1-year follow-up had no statistical difference between elderly group 1 and non-elderly group 1 or between elderly group 2 and non-elderly group 2 （allP〉0.05）. The percentage of died cases, and mortality and heart failure during 1-year follow-up had statistical difference between elderly group 1 and non-elderly group 1 （allP〈0.05）.Conclusion PCI is an effective therapy for ACS, but its influence on long-term prognosis in elderly patients with ACS needs further discussion.