急诊冠状动脉介入治疗老年急性心肌梗死的疗效

Efficacy of emergency PCI in elderly patients with acute myocardial infarction

目的 探讨急诊冠状动脉介入 (PCI)治疗老年急性心肌梗死 (AMI)的临床疗效。方法 131例连续行急诊PCI的AMI患者分为老年组 (37例 )和非老年组 (94例 ) ,分析两组患者一般临床特征及心血管事件的发生率。结果 老年组女性、高血压和无血流现象显著多于非老年组 ,而吸烟、术后TIMI 3级血流和支架植入数显著少于非老年组。住院期间老年组患者病死率 (10 .8%)高于非老年组 (0 %) (P <0 .0 1) ,复合终点事件的发生率 (10 .8%)亦高于非老年组 (1.1%) (P <0 .0 1) ;而两组在不稳定性心绞痛、非致死性再次心肌梗死、非致死性心力衰竭和缺血性靶血管重建等方面的差异均无显著性。随访 6个月时 ,老年组患者总病死率 (16 .2 %)明显高于非老年组 (2 .1%) (P <0 .0 1) ,非致死性心力衰竭的发生率 (2 1.2 %)亦明显高于非老年组 (4.3%) (P <0 .0 1) ;但两组在不稳定性心绞痛、非致死性再次心肌梗死、缺血性靶血管重建及复合终点事件的差异均无显著性。结论 急诊PCI治疗老年AMI疗效显著 ,但不如非老年AMI。

Objective To evaluate the efficacy of emergency percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI). Methods One hundred and thirty-one consecutive patients with AMI treated by emergency PCI were divided into the elderly AMI group (37 cases) and the non-elderly AMI group (94 cases). The baseline characteristics and cardiac events were analysed.Results In the elderly AMI group, female, hypertension and no-flow phenomena were more than those of the non-elderly AMI group, while smoking, TIMI-3 flow after the procedure and the proportion of stent implantation were less than those of the non-elderly AMI group. Compared with the non-elderly AMI group, in-hospital mortality (10.8% vs 0, P<0.01) and composite terminal events (10.8% vs 1.1%, P<0.01) were higher in the elderly AMI group, and no significant differences were observed in unstable angina, non-fatal reinfarction, non-fatal heart failure and ischemic target vessel revascularization between the two groups. During 6 months follow-up period, non-fatal heart failure (21.2% vs 4.3%, P<0.01) and total mortality (16.2% vs 2.1%, P<0.01) in the elderly AMI group were higher than those in the non-elderly AMI group, but there were no significant differences in unstable angina, non-fatal reinfarction and ischemic target vessel revascularization in the two groups (P>0.05).Conclusion The emergency PCI in the elderly AMI is effective, but not as good as that in the non-elderly AMI.