高龄老年冠心病患者介入治疗的临床特点及远期预后:单中心、大样本数据研究

Clinical Characteristics and Long-Term Outcomes in Elderly Patients with Coronary Heart Disease after Interventional Therapy:a Large Single-Center Study

目的探讨高龄老年冠心病患者行冠状动脉介入治疗(PCI)的临床特点和远期预后。方法连续纳入于2013年1—12月行PCI治疗的老年冠心病患者2981例,比较其中普通老年患者(65~74岁, n =2300,普通组)与高龄老年患者(≥75岁, n =681,高龄组)的临床特点及PCI术后2年随访期间的临床预后情况。结果高龄组BMI、左室射血分数(LVEF)、术前肾小球滤过率(eGFR)、使用钙离子拮抗剂等以及冠状介入情况(经桡动脉途径等)的比例较普通组低( P <0.05);既往PCI史、使用质子泵抑制剂等的比例以及冠状动脉病变情况(左主干病变、右冠状动脉病变、术前SYNTAX评分、严重钙化病变等)较普通组高( P <0.05)。2年随访结果显示,高龄组全因死亡、心源性死亡以及支架内血栓的发生率明显高于普通组( P <0.05);主要不良心脑血管事件、再发心肌梗死、血运重建(靶血管和靶病变血运重建)、脑卒中、出血以及大出血的发生率比较,2组差异无统计学意义( P >0.05)。高龄组中,女性全因死亡、心源性死亡以及再发心肌梗死的发生率明显高于男性( P <0.05)。单因素和多因素COX回归分析显示,术后2年随访期间,年龄是老年冠心病患者发生支架内血栓的独立危险因素( P <0.05),不是全因死亡以及心源性死亡的独立危险因素( P >0.05);既往脑血管病史是全因死亡的独立危险因素( P <0.05);使用主动脉内球囊反搏(IABP)、较好的心肾功能、经桡动脉途径是全因死亡以及心源性死亡的独立保护因素( P <0.05);女性是高龄患者全因死亡的独立危险因素( P <0.05),不是心源性死亡和再发心肌梗死的独立危险因素( P > 0.05)。结论高龄老年冠心病患者合并较差的心肾功能以及程度较重的冠状动脉病变。PCI术后2年随访期间:1)全因死亡、心源性死亡以及支架内血栓的发生率较高。2)经校正多种危险因素后,年龄不是老年冠心病患者全因死亡以及心源性死亡的独立危险因素,而是支架内血栓的独立危险因素;女性是高龄老年冠心病患者全因死亡的独立危险因素,不是心源性死亡和再发心肌梗死的独立危险因素。

Objective To investigate the clinical characteristics and long-term prognosis of elderly patients with coronary heart disease(CHD) undergoing percutaneous coronary intervention(PCI). Methods A total of 2981 elderlypatients with CHD who underwent PCIfrom January to December 2013were enrolledin the study.These patients were divided into normal group(65-74 yearsold, n =2300,1473 males and 827 females) and elderly group(≥75 yearsold, n =681,410 males and 271 females).Clinical characteristics and outcomes after 2 years of follow-up were compared between the two groups. Results Body mass index,left ventricular ejection fraction,preoperative glomerular filtration rate and percentage of patients usingcalcium antagonistsor receiving coronary intervention(transradial approach,etc.) in elderly groupwere lower than those in normal group( P <0.05).The percentage of patients withPCIhistoryor using proton pump inhibitors(PPI) and the incidence of coronary artery lesions(left main artery disease,right coronary artery disease,preoperative SYNTAX scores,severe calcification lesions,etc.) in elderly group were higher than those in normal group( P <0.05).The 2-year follow-up results showed that the incidence of all-cause death,cardiac death and stent thrombosis in elderly group was higher than that in normal group( P <0.05).There were no significant differences in the incidence of major adverse cardio/cerebrovascular events,recurrent myocardial infarction,revascularization(target vessel revascularization and target lesion revascularization),stroke,hemorrhage and massive hemorrhage between the two groups( P >0.05).In elderly group,the incidence of all-cause death,cardiogenic death and recurrent myocardial infarction in females was higher than that in males( P <0.05).Univariate and multivariate COX regression analysis showed that age was an independent risk factor for stent thrombosis( P <0.05),but not for all-cause and cardiogenic deaths( P >0.05).Previous history of cerebrovascular disease was an independent risk factor for all-cause mortality( P < 0.05);The use of IABP,good cardio-renal function and transradial approach were the independent protective factors for all-cause death and cardiac death( P <0.05).Femalegender was an independent risk factor for all-cause death( P <0.05),but not for cardiac death and recurrent myocardial infarction in elderly patients( P >0.05). Conclusion Elderly patients with CHD had poor cardiorenal function and severer coronary artery lesion.During 2 years of follow-up after PCI,the incidence of all-cause death,cardiogenic death and stent thrombosis was high among elderly CHD patients.After adjusting for various risk factors,the age an independent risk factor for stent thrombosis,but not for all-cause death and cardiac death.Female gender was an independent risk factor for all-cause death,but not for cardiac death and recurrent myocardial infarction in elderly patients with CHD.