老年急性心肌梗死患者临床特点和直接经桡动脉介入治疗疗效评价

Clinical characteristics and the therapeutic effect of coronary intervention by radial approach for elderly patients with acute myocardial infarction

目的分析老年急性ST段抬高型心肌梗死(STEMI)患者临床和冠脉病变特点,评价经桡动脉直接介入治疗的可行性和安全性。方法选取2011年1月至2015年5月因STEMI在我院行冠状动脉介入治疗的患者,年龄≥65岁为老年组共105例,年龄<65岁为对照组,共102例。观察2组临床特征和冠脉病变特点以及直接经桡动脉介入治疗效果。结果 (1)临床特征:老年组典型胸痛症状比例低于对照组(P<0.05),明确诱因比例高于对照组(P<0.05),发病至入院时间长于对照组(P<0.05),术中行临时起搏和电复律的比例高于对照组(P<0.05);(2)冠脉病变特点和手术效果:老年组多支病变和球囊预扩张比例高于对照组(P<0.05),单支病变、血栓抽吸和使用糖蛋白Ⅱb/Ⅲa受体抑制剂(GPI)的比例低于对照组(P<0.05);桡动脉穿刺成功率、手术成功率和手术时间组间比较无统计学差异(P>0.05),门-球囊时间长于对照组(P<0.05),但2组间门-球囊时间<90 min的患者比例并无差异(P>0.05);(3)并发症和心脏不良事件:2组出血和支架内血栓发生率无统计学性差异(P>0.05),老年组心脏功能Killip≥Ⅲ级者多于对照组(P<0.05),术后24 h左室射血分数(LVEF)低于对照组(P<0.05),但住院期间2组病死率差异无统计学意义(P>0.05)。结论虽然老年STEMI患者临床和冠脉病变特点与年轻患者相比有所不同,但经桡动脉直接冠状动脉介入治疗与年轻患者一样是安全有效的。

Objective To investigate clinical and coronary artery lesion characteristics in the elderly patients with ST-elevated myocardial infarction（ STEMI）, and to evaluate the feasibility and safety of interventional treatment by radial approach. Methods Patients with STEMI who had received coronary artery intervention treatment from January 2011 to April 2015 in our hospital were selected, and according to the age they were divided into elderly group （aged ≥ 65 years old, n= 105） and the control group （aged〈65 years old, n= 102）. Clinical characteristics and coronary lesions were observed, and the efficacy of percutaneous coronary intervention was compared between the two groups. Results （ 1 ） Compared with control group, the ratio of typical chest pain was lower, the ratio of explicit incentive was higher, onset to admission time was longer, temporary pacemaker and cardioerter ratio was higher in the elderly group （ P〈 0. 05）.（2） Compared with control group, muhivessel lesion and balloon expansion ratio was higher, the proportion of single lesion, thrombus suction, and using GP II b/III a receptors inhibitors was lower in elderly group （P〈0. 05 ）. There was no significant difference in success rate of radial artery puncture and operation, operation time between two groups （ P〉0. 05）. The door to balloon time was longer in elderly group than that in the control group （ P〈0. 05 ）, but there was no significant difference between the two groups （ P〉 0. 05 ） in the ratio of door to balloon time less than 90 min. （ 3 ） There was significant difference in bleeding and stent thrombosis between two groups （ P〈 0. 05 ）, and ratio of heart function Killip ≥ grade Ⅲ in elderly group was more than that in the control group （ P〈 0.05 ）. Postoperative 24 hours LVEF value was lower than that of the control group （ P〈 0. 05 ）, but the mortality rate during hospitalization had no significant difference between the two groups （ P〉 0. 05 ）. Conclusions Although the aged patients with acute myocardial infarction have different clinical features and coronary lesions from the young patients, the interventional treatment by radial approach has the same safety and effectiveness.