老年无保护左主干冠状动脉病变患者行药物涂层支架植入术的远期预后分析

Long-term prognosis of drug eluting stents implantation in elderly patients with unprotected left main coronary artery disease

目的分析老年无保护左主干冠状动脉病变患者行药物涂层支架(DES)植入术的远期预后。方法纳入2005年1月至2010年3月入住北京安贞医院心内科的无保护左主干冠状动脉病变行DES植入术患者414例,年龄(61.5±10.7)岁,男327例,女87例。根据年龄将其分为两组,年龄<70岁组300例,年龄≥70岁组114例。比较两组患者临床特点,分析不同年龄组冠状动脉病变及远期临床预后。结果与年龄<70岁组比较,年龄≥70岁组女性所占比例较高(31.6%比17.0%,P=0.001),慢性完全闭塞病变(P=0.020)、高血压(P=0.018)、脑血管病(P=0.013)患病率较高,全因死亡与心源性死亡发生率较高(P=0.025、0.013)。随访(21.4±9.6)个月。多因素分析显示,主要不良心脑血管事件(MACCE)、心肌梗死、脑卒中、再次血运重建发生率在两组间差异无统计学意义,年龄≥70岁组全因死亡(HR=3.790,95%CI:1.271~11.298,P=0.017)、心源性死亡(HR=17.424,95%CI:2.440~124.410,P=0.004)发生风险高于年龄<70岁组。结论年龄是无保护左主干病变DES支架植入术后死亡的独立危险因素。年龄≥70岁患者合并冠状动脉无保护左主干病变行药物涂层支架植入术可行,但需谨慎对待。

Objective To analyze the clinical characteristics and long-term prognosis of implantation of drug-eluting stents(DES)for elderly patients with unprotected left main artery(ULM)disease.Methods A total of 414 patients(327 males and 87 females)who underwent DES implantation were enrolled in the Department of Cardiology,Beijing Anzhen Hospital from January 2005 to March 2010,with a mean age of(61.5±10.7)years old.The patients were divided into two groups according to age:300 cases in the group of age<70 years old,and 114 cases in the group of age≥70 years old.The clinical characteristics and long-term prognosis of two groups were compared.Results In the group of age≥70 years old,the proportion of female was higher(31.6%vs 17.0%,P=0.001)and the incidence of chronic total occlusion(CTO)(P=0.020),hypertension(P=0.018)and cerebrovascular disease(P=0.013)were higher than those in the group of<70 years old.All-cause mortality and cardiac mortality were also higher than those in the group of<70 years old(P=0.025,P=0.013).The follow-up period was(21.4±9.6)months.After adjusting for multiple clinical factors,there were no statistical differences of incidence of the total major adverse cardiac and cerebral events(MACCE),myocardial infarction,cerebrovascular events,and revascularization recurrence between the two groups.But all-cause mortality(HR=3.790,95%CI:1.271-11.298,P=0.017)and cardiac mortality(HR=17.424,95%CI:2.440-124.410,P=0.004)in the group of age≥70 years old were still remarkably higher than those in the group of<70 years old.Conclusions Age is an independent risk factor for increased mortality after DES stent implantation in ULM disease.DES stent implantation in age≥70 years old patients with ULM disease is considered feasible,but it needs to be treated with caution.