不同途径介入治疗老年冠心病患者的临床疗效观察

Treating Elderly Coronary Heart Disease Patients by Different Approaches of Percutaneous Coronary Intervention:an Observation of Clinical Efficacy

目的 观察不同途径经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）对不同年龄段老年冠心病患者的临床疗效。方法 将470例老年冠心病患者分为3个年龄段（年龄≥85岁、60~74岁和75~84岁）,并根据患者行PCI采取的不同穿刺途径分为桡动脉途径（transradial intervention,TRI）组236例和股动脉途径（transfemoral intervention,TFI）组234例。比较两组患者不同年龄术中相关情况及术后临床疗效。结果 与本组年龄≥85岁比较,两组中年龄60~74岁和75~84岁患者的手术成功率明显增高,术后12、24个月心脑血管事件（maior cardiovascular events,MACE）发生率降低,TRI组中更换穿刺途径例数增多,差异有统计学意义。

Objective To observe the efficacy of different ways of percutaneous coronary intervention（PCI） for treating elderly coronary heart disease（CHD） patients.Methods Totally 470 elderly CHD patients were classified to three age brackets（equal to or more than 85 years old,60 to 74 years old,75 to 84 years old）.They were assigned to the transradial intervention（TRI） group（236 cases） and the transfemoral intervention（TFI） group（234 cases） according to different intervention pathways.Correlated indices and postoperative clinical efficacy were compared between the two groups.Results A higher successful rate of surgery was obviously got in patients 85 years old or older than 85 than in those 60 to 74 years old and 75 to 84 years old（P0.05）.The incidence of major cardiovascular events（MACE） was reduced at post-operative 12 and 24 months in patients 85 years old or older than 85（P0.05）.The case number for changing intervention pathway were increased in the TRI group with statistical difference（P 0.05）.Compared with the TFI group,the case number for changing intervention pathway was increased;the time for arteriopuncture,the time for catheterization,and the time for X-ray exposure were prolonged;the time for postoperative bedding were obviously shortened;the incidence of vascular complications at the puncture site were lowered.The incidence of postoperative 12-month MACE was lowered,all with statistical difference（all P0.05）.The incidence of MACE within postoperative 24-month MACE decreased in patients 60 to 74 years old and 75 to 84 years old（P 0.05）.The incidence of MACE within postoperative 24 months increased in patients 85 years old or older than 85 of the TRI group with statistical difference（P 0.05）.Conclusion TRI can be preferably chosen for PCI in treating elderly CHD patients.