高龄急性心肌梗死患者的临床表现及冠状动脉病变特征

Clinical manifestations and characteristics of coronary artery disease in advanced age patients with acute myocardial infarction

目的探讨高龄急性心肌梗死(AMI)患者的临床表现和冠状动脉(冠脉)病变特征。方法 570例AMI患者根据年龄分为三组:非老年组242例,年龄<65岁;老年组230例,年龄65～74岁;高龄组98例,年龄≥75岁。比较三组临床症状、危险因素和冠脉病变的严重程度。结果随着年龄的增加,男性、吸烟史、早发冠心病家族史、典型胸痛为首发症状、接受冠脉造影和经皮冠脉介入治疗的比例降低(P<0.05),合并糖尿病的比例升高(P<0.05),就诊时间延长(P<0.05)。与非老年组相比,老年组和高龄组发生非ST段抬高型心肌梗死、心源性休克、肺水肿和再发心肌梗死的比例升高(P<0.05),高龄组发生急性肾衰竭的比例和病死率升高(P<0.05)。高龄组左主干和右冠脉受累的比例高于老年组和非老年组(P<0.05);老年组和高龄组左回旋支受累及其作为梗死相关动脉和钙化病变的比例高于非老年组,而完全闭塞和血栓影的比例低于非老年组(P<0.05)。随着年龄的增加,Gensini积分和冠脉病变支数增加(P<0.05),冠脉重度狭窄(76%～95%狭窄)的比例增加(P<0.05)。三组即刻手术成功率和手术并发症发生率相仿(P>0.05)。结论高龄AMI患者首发症状常不典型,心源性休克、肺水肿、急性肾衰竭发生率和病死率高,冠脉病变复杂,多支病变、闭塞性和钙化性病变增加,但不影响急诊冠脉即刻手术成功率。

Objective To discuss the clinical manifestations and characteristics of coronary artery disease in advanced age patients with acute myocardial infarction（AMI）.Methods A total of570 consecutive AMI patients was divided into three groups,who were the patients aged 〈65 years old（group A,242 cases）,65 to 74 years old（group B,230 cases）and ≥75 years old（group C,98 cases）,respectively.The clinical symptoms,risk factors and severity of coronary artery disease were compared among three groups.Results Along with the increase of the age,the proportion of male,smoking history,family history of premature coronary heart disease,typical chest pain as the first onset symptom,coronary angiography and percutaneous coronary intervention was decreased（P〈0.05）,the proportion of diabetes was increased（P〈0.05）,and the time for consultation was prolonged（P〈0.05）.Compared with group A,the proportion of non-ST segment elevation myocardial infarction,cardiogenic shock,pulmonary edema and recurrent myocardial infarction was increased in groups of B and C（P〈0.05）,and the proportion of acute renal failure and mortality were increased in group C（P〈0.05）.The proportion of left main coronary artery and right coronary artery involvement in group C was higher than that in groups of A and B（P〈0.05）.The proportion of left circumflex artery involvement,left circumflex artery as infarct-related artery and calcification in groups of B and C was higher,while the proportion of complete occlusion and thrombosis was lower than that in group A（P〈0.05）.Along with the increase of the age,Gensini score and the number of diseased coronary arteries and the proportion of severe coronary stenosis were increased（P〈0.05）.Immediate surgical success rate and incidence of surgical complication of three groups were similar（P〉0.05）.Conclusion In the advanced age patients with AMI,the first onset symptom is often atypical,the incidence of cardiaogenic shock,pulmonary edema,acute renal failure and mortality are higher,coronary artery lesions are complex,and multiple lesions,occlusion and calcification are increased,but the immediate success rate of coronary artery emergency surgery is not affected.