不同年龄段人群冠状动脉内药物涂层支架置入术后远期随访研究

Long-term follow up study of drug-eluting stent in patients of different ages with coronary heart disease

目的评价年龄因素对选择性冠状动脉内置入雷帕霉素洗脱支架(DES)的远期疗效的影响。方法对成功置入DES的316例男性冠心病患者进行随访调查,根据年龄分组:>80~90岁组(82例)、>70~80岁组(80例)、>60~70岁组(92例)、>45~60岁组(62例)。比较4组的随访结果,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果 4组支架术成功率均为100%,随访率100%,随访5年,4组术后并发症发生率、卒中发生率差异无统计学意义(均P>0.05)。再次血运重建率(10.9%、13.4%、19.6%、22.6%)和心绞痛复发率(15.9%、20%、32.6%、40.3%)>80~90岁、>70~80岁组低于>60~70岁组、>45~60岁组(P<0.05),全因病死率>80~90岁组、>70~80岁组高于>60~70岁组、>45~60岁组(7.3%、6.3%、2.2%、1.6%,P<0.05),但心源性病死率差异无统计学意义。结论年龄因素对冠脉内支架术的疗效及安全性无明显影响。

Objective To assess the age factor on the long-term clinical outcomes in patients with coronary artery disease after the application of drug eluting stent ( DES) .Method A total of 316 patients with coronary artery disease,who underwent DES implantation in a single center from January 2004 toJanuary 2008 were included and di-vided into four groups:groupⅠ( patients aged 80-89 years old,n=82),groupⅡ(patients aged 70-79 years old, n=80).groupⅢ(patients aged 60-69 years old,n=92),and groupⅣ( patients with 40-59 years old,n=62). The long-term outcomes were compared among the four groups .The five years follow-up clinical end points of death , myocardial infarction ,stroke and any repeat revascularization were collected mainly by telephone interview after dis -charge retrospectively .Results Procedural success rates were 100%in the 4 groups.After the 5 years 100%follow-up,there were no significant differences in the incidence of complications ,and non-fatal stroke (P>0.05).The rates of reascularization (15.9%vs 20%vs 32.6% vs 40.3%) and recurrent angina (10.9% vs 13.4% vs 19.6% vs 22.6%) were were significantly lower in group ⅠandⅡ than that in groupⅢ and=Ⅳ,respectively (P <0.05). The all-cause mortality was higher in group I(7.3%)and Ⅱ(6.3%)than that in groupⅢ(2.2%) andⅣ(1.6%) (P <0.05).There were no was no significant differences in the cardiac mortality among four groups .Conclusion There is no significant influence of age factor on the prognosis and safety after the elective coronary stenting .