老年冠状动脉慢性闭塞性病变患者介入治疗的特点及转归

Analysis of percutaneous coronary intervention in elderly patients with chronic total occlusion

目的通过分析老年冠状动脉慢性闭塞病变（coronary chronic total occlusion,CTO）患者接受介入治疗后的临床特点及预后情况,探讨不同年龄段的老年CTO患者行经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗的可行性和安全性。方法回顾性分析我院2012年7月至2014年6月住院行PCI治疗的老年CTO患者共211例,按年龄分为高龄老年组73例,年龄≥75岁,平均（80.9±3.4）岁;老年组138例,年龄60-75岁,平均（68.3±5.7）岁;并以同期106例行PCI的中青年CTO患者为非老年组,年龄〈60岁,平均（51.3±6.9）岁,比较3组患者的临床特点、冠状动脉造影血管病变程度、血管开通率、围手术期并发症及预后情况等。结果 3组的CTO靶血管迂曲和（或）钙化的比例随年龄增加而升高,高龄老年组及老年组的比例均高于非老年组,两两比较差异有统计学意义（P〈0.05）;高龄老年组与PCI相关的心肌梗死的发生率较老年组及非老年组高（P〈0.05）,但3组患者的冠状动脉病变血管数目、闭塞病变位置、闭塞病变开通率、随访术后主要心血管事件发生率差异均无统计学意义（P〉0.05）。结论不同年龄段的老年CT0患者行PCI治疗的手术成功率及预后情况与非老年组CTO患者相当,老年CTO病变的介入治疗可行;但老年患者血管迂曲钙化较非老年患者严重,应警惕并发症。

Objective To analyze the clinical features and prognosis in elderly patients with chronic total occlusion（CTO）receiving percutaneous coronary intervention（PCI）,and to explore the feasibility and safety of PCI in elderly patients with CTO.Methods Two hundred and eleven elderly patients with CTO comfirmed by coronary angiography and treated with PCI from July 2012 to June 2014 in Tongji Hospital were retrospectively analyzed.All patients were divided into two groups according to age,very elderly group（age≥75years old,mean 80.9±3.4years old,73cases）and eldely group（age from 60 to 75years old,mean 68.3±5.7years old,138cases）.A total of 106 cases with CTO treated with PCI under the age of 60 were selected as young group and retrospectively analyzed（mean51.3±6.9years old）.Clinical characteristics vascular lesions in coronary angiography,recanalization rate of occlusive vessels,perioperative complications and prognosis were analyzed and compared among three groups.Results The incidence of tortuosity and/or calcification increased sharply with age and was significantly higher in very elderly group and elderly group than in young group（P〈0.05）.The rate of PCI-associated myocardial infarction in very elderly group was significantly higher than that of other two groups（P〈0.05）.However,there were no significant difference in the number and the location of occlusive vessel branches,the recanalization rate of occlusive vessel and the incidence of main cardiovascular event among three groups（P〈0.05）.Conclusion There were no significant difference in the success rate of PCI and the prognosis of main cardiovascular event between elderly patients with CTO and young patients with CTO.PCI is feasible and safe in elderly patients with CTO.