经皮冠状动脉介入治疗对高龄急性冠状动脉综合征患者预后的影响

Influence of percutaneous coronary intervention on the prognosis of acute coronary syndrome in elderly patients

目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)对高龄急性冠状动脉综合征(acute coronary syndrome,ACS)患者预后的影响。方法 2011年11月至2013年9月承德医学院附属医院心内科住院的ACS患者共1640例,连续入选所有符合纳入标准的老年ACS患者374例,根据是否行PCI术分为PCI组(55例)和保守治疗组(319例)。收集患者的临床资料并随访评价预后。结果两组性别构成比,高血压病、2型糖尿病、血脂异常等患病率,吸烟史、既往心力衰竭史、急性肺水肿、心原性休克发生率等比较,差异均无统计学意义(均P>0.05)。两组阿司匹林、血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂、β阻滞剂、他汀等用药比较,差异均无统计学意义(P>0.05)。PCI组氯吡格雷处方率显著高于保守治疗组(P<0.001)。PCI组全因死亡率及主要不良心血管事件发生率低于保守治疗组。Cox多因素模型分析显示,心原性休克、急性肺水肿、既往心力衰竭病史及女性均为老年ACS患者远期预后不良的独立危险因素,HR值依次为8.00、4.61、7.51、3.57(均P<0.05);而PCI是老年ACS患者远期预后的保护因素(HR 0.21,P<0.05)。结论PCI可降低老年ACS患者的全因死亡率与主要不良心血管事件发生率,显著改善预后。

Objective To investigate the influence of percutaneous coronary intervention（ PCI）on the prognosis of acute coronary syndrome（ ACS） in the elderly（ age 〉75 years old）. Methods There were 1640 patients with ACS admitted in the cardiology department in our hospital from December 2011 to September 2013. Among the 374 patients with ACS who fulfilled the inclusion criteria were consecutively enrolled in this study. They were divided into two groups： PCI group（ 55 /374,14. 71%） and conservative medical treatment group（ 319 /374,85. 29%）. All the clinical data were collected and regularly followed up. Results There were no statistical significance between the two groups in the sex,co-morbidities of hypertension,diabetes,dyslipidemia,history of smoking and heart failure at admission,all P〉0. 05. The history of acute pulmonary edema and cardiogenic shock had no statistical significance between the two groups,P〉0. 05. Medlication received by patients in the 2 groups including aspirin,ACEI,ARB,beta blockers and statins showed no differences, P〉0. 05. However, more patients were prescribed with clopidogrel in the PCI group than patients in the conservative treatement group,P〈0. 05. We found that patients in the PCI group had higher all cause mortality and major adverse cardiovascular events than patients in the conservative treatment group,P〈0. 05. In the COX proportional hazard model,cardiogenic shock（ HR 8. 00）,acute pulmonary edema（ HR 4. 61）,heart failure history（ HR 7. 51） and female（ HR 3. 57）were found to be independent risk factors for bad prognosis in ACS patients over 75 years old,all P〈0. 05.However,PCI was a protective factor for ACS in the elderly（ HR 0. 21,P = 0. 02）. Conclusions PCI may reduce the all cause mortality and incidence of major adverse cardiovascular events for the ACS patients over 75 years old,which should be a preferable treatment to improve the long term prognosis of them.