75岁及以上人群经皮冠状动脉介入术后短期死因分析

Short-term causes of death in Chinese elderly patients(≥75years old)after percutaneous coronary intervention

目的:分析≥75岁老年冠心病患者经皮冠状动脉介入(PCI)治疗后18个月的死亡原因。方法:单中心回顾性研究连续入选2015年1-12月行PCI的≥75岁患者,收集其临床资料,并随访,分析患者死亡原因。结果:451例老年患者行PCI,平均随访17个月,死亡53例。院内及术后6个月的死亡率分别为17%(9例)和50.9%(27例)。院内、6、12、18个月的全因(心血管)死亡率分别为:2%(2%)、5.8%(4.8%)、8.7%(5.5%)、12.1%(7.4%)。累计生存曲线显示,术后160d的全因死亡及心血管死亡的Kaplan-Meier曲线走势趋近。术后6个月最常见的死因为:心力衰竭(13.2%)、猝死(9.4%)和心源性休克(7.5%)。此后,非心血管死亡占57.7%。至随访结束,最常见死因为心力衰竭(24.5%)。结论:≥75岁的冠心病患者PCI术后的最初160d,心血管死亡是主要死因;应注重防治心力衰竭。

Objective：To identify causes of death among elderly patients（≥75 years old）within 18 months after percutaneous coronary intervention（PCI）.Method：We consecutively enrolled patients with age≥75 years old and underwent PCI from January to December 2015.Clinical data and causes of death were collected and analyzed.Result：In total,451 patients were enrolled and were followed up for averaging 17 months,including 53 dead patients.In-hospital and 6-month mortality constituted 17%（n=9）and 50.9%（n=27）,respectively.In-hospital,6-month,12-month and 18-month all-cause（and cardiovascular）mortality rates were 2%（2%）,5.8%（4.8%）,8.7%（5.5%）and 12.1%（7.4%）,respectively.Cumulative survival curves showed high conformity between allcause mortality and cardiovascular mortality within 160 days.The most frequent causes of death within 6 months were heart failure（13.2%）,sudden death（9.4%）,and cardiogenic shock（7.5%）.After 6 months,noncardiovascular causes of death accounted for 57.7% of cases.During the 18-month follow-up,heart failure（24.5%）accounted for the most deaths.Conclusion：Elderly patients aged≥75 years face a high risk of cardiovascular death during the first 160 days after PCI.Heart failure warrants special attention throughout the 18-month follow-up.