75岁以上急性冠状动脉综合征患者介入诊疗情况及影响因素分析

PCI for ≥75 years old acute coronary syndrome patients and its influencing factors

目的分析年龄≥75岁非ST段抬高型急性冠状动脉综合征(non-ST-segment elevation acute coronary syndrome,NSTEACS)患者PCI诊疗情况及影响因素。方法收集2008年1月~2015年12月郑州大学附属洛阳中心医院出院诊断为NSTEACS患者475例,其中年龄<75岁患者357例(<75岁组),≥75岁患者118例(≥75岁组)。≥75岁组又根据治疗情况分为PCI诊疗组33例和药物保守组85例。收集性别、年龄、吸烟、饮酒、高血压、2型糖尿病、PCI史、陈旧性心肌梗死、脑卒中、慢性肾病、冠状动脉造影及PCI诊疗情况。分析年龄≥75岁NSTEACS患者接受PCI诊疗的影响因素。结果≥75岁组年龄明显高于<75岁组,冠状动脉造影、冠心病、PCI比例明显低于<75岁组(28.0%vs 50.7%,P=0.001;22.9%vs 40.3%,P=0.027;16.1%vs 25.2%,P=0.032)。与药物保守组比较,PCI诊疗组非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)、血红蛋白水平明显升高[27.3%vs 17.6%,P=0.024;(155.6±19.3)g/L vs(120.6±17.8)g/L,P=0.006],肌酐水平明显降低[(74.7±21.7)μmol/L vs(89.0±27.3)μmol/L,P=0.028]。多因素logistic回归分析显示,血红蛋白、NSTEMI与年龄≥75岁NSTEACS患者冠状动脉造影呈正相关(OR=1.006,95%CI:1.002~1.022,P=0.043;OR=4.420,95%CI:1.072~18.221,P=0.040),肌酐与冠状动脉造影呈负相关(OR=0.968,95%CI:0.945~0.992,P=0.025)。结论年龄≥75岁NSTEACS患者冠状动脉PCI诊疗率低,NSTEMI是PCI诊疗的促进因素,低血红蛋白水平和高肌酐水平是阻碍因素。

Objective To analyze the PCI for≥75 years old acute coronary syndrome(ACS)patients without ST segment elevation and its influencing factors.Methods Four hundred and seventy-five ACS patients without ST segment elevation admitted to our hospital from January 2008 to December 2015 were divided into<75 years old group(n=357)and≥75 years old group(n=118).The patients in≥75 years old group were further divided into PCI group(n=33)and conservative treatment group(n=85).The following clinical data were recorded,namely gender,age,smoking history,alcohol drinking history,PCI history,incidence of old myocardial infarction,hypertension,DM,cerebral stroke,chronic kidney disease,and coronary angiography parameters.The influencing factors of PCI in≥75 years old ACS patients without ST segment elevation were analyzed.Results The ratio of coronary angiography and incidence of coronary heart disease and the rate of PCI were significantly lower in≥75 years old group than in<75 years old group(28.0%vs 50.7%,P=0.001;22.9%vs 40.3%,P=0.027;16.1%vs 25.2%,P=0.032).The incidence of myocardial infarction without ST segment elevation and the serum hemoglobin level were significantly higher while the serum creatinine level was significantly lower in PCI group than in conservative treatment group(27.3%vs 17.6%,P=0.024;155.6±19.3 g/L vs 120.6±17.8 g/L,P=0.006;74.7±21.7μmol/L vs 89.0±27.3μmol/L,P=0.028).Multivariate logistic regression analysis showed that serum hemoglobin level and myocardial infarction without ST segment elevation were positively related while serum creatinine level was negatively related with coronary angiography parameters(OR=1.006,95%CI:1.002-1.022,P=0.043;OR=4.420,95%CI:1.072-18.221,P=0.040;OR=0.968,95%CI:0.945-0.992,P=0.025).Conclusion The rate of PCI for≥75 years old myocardial infarction patients without ST segment elevation is low.Myocardial infarction without ST segment is a promoting factor while low serum hemoglobin and creatinine level is an obstructive factor for PCI.