经皮冠状动脉介入术治疗合并左室射血分数降低老年冠心病患者临床效果及安全性

Clinical efficacy and safety of percutaneous coronary intervention in elderly patients with coronary heart disease combined with decreased left ventricular ejection fraction

目的探讨经皮冠状动脉介入术(PCI)治疗合并左室射血分数(LVEF)降低的老年冠心病患者的临床效果及安全性。方法选取北部战区总医院自2017年1月至2018年12月收治的接受PCI治疗且LVEF<50%的1989例冠心病患者为研究对象。根据年龄,将患者分入非老年组(年龄<65岁)和老年组(年龄≥65岁)。比较两组患者的基线资料、围术期指标、术后用药情况及术后1年的不良事件发生情况。结果两组患者年龄、肾小球滤过率、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、N末端脑钠肽前体,以及性别、高血压病史、吸烟史、既往冠状动脉旁路移植术、既往卒中、冠心病家族史、疾病分类比例比较,差异均有统计学意义(P<0.05)。两组患者介入治疗入路为桡动脉、股动脉的比例及靶血管位置为左前降支的比例比较,差异均有统计学意义(P<0.05)。两组患者术后应用P2Y12抑制剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β受体阻滞剂的比例比较,差异均有统计学意义(P<0.05)。老年组患者全因死亡、主要不良心脑血管事件、心源性死亡的发生率均高于非老年组,差异有统计学意义(P<0.05)。结论合并LVEF降低的老年冠心病患者接受PCI治疗的远期预后较差,主要归因于全因死亡及心源性死亡的发生率升高,但PCI不会增加非致死性心肌梗死、缺血性卒中、靶血管血运重建的发生风险,对于LVEF降低的老年冠心病患者出院后的长期管理策略需进一步研究。

Objective To investigate the clinical efficacy and safety of percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease combined with decreased left ventricular ejection fraction(LVEF).Methods 1989 coronary heart disease patients with LVEF<50%and PCI treated in the General Hospital of Northern Theater Command from January 2017 to December 2018 were selected as subjects.According to age,patients were divided into non⁃elderly group(age<65 years)and elderly group(age≥65 years).Baseline data,perioperative indexes,postoperative medication and adverse events 1 year after surgery were compared between the two groups.Results There were statistically significant differences in age,glomerular filtration rate,total cholesterol,tri⁃glyceride,high density lipoprotein,low density lipoprotein,N⁃terminal brain natriuretic peptide precursor,gender,history of hyperten⁃sion,smoking history,previous coronary artery bypass grafting,previous stroke,family history of coronary heart disease and disease classification between 2 groups(P<0.05).There were statistically significant differences in the proportion of radial artery and femoral artery as the interventional approach and the proportion of left anterior descending branch as the target vessel between 2 groups(P<0.05).There were statistically significant differences in the proportions of P2Y12 inhibitors,angiotensin converting enzyme inhibitors/angiotensin receptor blockers andβreceptor blockers used after surgery between 2 groups(P<0.05).The incidence of all⁃cause death,major unscrupulous cerebrovascular events and cardiac death in the elderly group was higher than that in the non⁃elderly group,and the difference was statistically significant(P<0.05).Conclusion Elderly patients with coronary heart disease with decreased LVEF undergoing PCI have poor long⁃term prognosis,which is mainly attributed to the increased incidence of all⁃cause death and cardiogenic death,but PCI does not increase the risk of non⁃fatal myocardial infarction,ischemic stroke and target vessel revascularization.