Anticoagulation therapy in intra-aortic balloon counterpulsation： Does IABP really need anti-coagulation ？

Objective: To investigate if intra-aortic balloon pump(IABP) is contraindicated without anticoag-ulation therapy. Methods: Some 153 IABP patients in the King Abdulaziz Cardiac Center(KSA) were random-ly assigned into two groups. Anticoagulation group( Group A) consisted of 71 patients who were given heparin intravenously with target aPTT 50 - 70 seconds. Non-anticoagulation group( Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including platelet count, D-dimer, Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen degradation products(FDP) were checked respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon surface, vascular complications from IABP including bleeding and limb ischemia were recorded.Results: Platelet count and PAI-1 level decreased at 24 hours and 48 hours in both groups ( P < 0.05) . D-dimer and FDP level increased at 24 hours and 48 hours in both groups( P < 0.05), but returned to the baseline level 24 hours post IABP removal( P > 0.05) . Three patients in Group A and 2 patients in Group B developed minor limb ischemia( P > 0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A, but only 2 patients in Group B ( P <0.05). No clot deposit developed on IABP surface in either group. Conclusion: IABP is safe without routine anticoagulation therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications.

Preoperative Intra-Aortic Balloon Counterpulsation in Coronary Artery Bypass Graft Patients with Severe Left Ventricular Dysfunction

Background: The intra-aortic balloon pumping (IABP) is the most used ventricular mechanical assist device. In recent years, the preoperative use in patients with severe ventricular dysfunction presents itself as a great benefic strategy to the postoperative recovery. This paper aim is to evaluate the IABP post-operative benefit in patients with severe ventricular dysfunction. Methods: From January 2011 to March 2016, 125 patients underwent a coronary artery bypass graft (CABG) with cardiopulmonary bypass and preoperative IABP in Teaching Hospital of the ABC Medical School and Hospital Estadual Mario Covas. The inclusion criteria were the presence of severe ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) less than or equal to 40%, estimated by Doppler echocardiography using the Simpson method. The preoperative LVEF was 30.25% ± 8.53% and the diastolic diameter of the left ventricle (LVDD) 67.75 ± 16.37 mm. IABP was installed approximately 15 hours before the surgery. Results: The patients required the IABP for 2.4 ± 1.58 days, and vasoactive drugs, 4.8 ± 2.12 days. We performed 3.2 ± 1.9 grafts per patient and the total length of stay was 07 ± 5.52 days. Cardiopulmonary bypass time was 67 ± 10.95 minutes and anoxia time, 46.4 ± 10.06 minutes. Twelve patients (9.6%) had pneumonia and four (3.2%), atrial fibrillation. We observed a LVDD reduction to 63 ± 16.26 (p = 0.068) and LVEF enhancement to 36.50 ± 16.86 (p = 0.144). The data were analyzed statistically according to the Wilcoxon test. There were no deaths. Conclusion: The initial experience of the authors with the preoperative IABP in patients with severe left ventricular dysfunction suggests great benefit in post-operative recovery with im-provement of LVEF and reduction of LVDD.

Concurrent implantation of intra-aortic balloon pumping with extracorporeal membrane oxygenation improved survival of patients with postcardiotomy cardiogenic shock

Background Extra-corporeal membranous oxygenation (ECMO)and intra-aortic balloon pumping (IABP) are widely used in patients with severe circulatory failure. The decision to initiate ECMO and IABP on optimal occasion in postcardiotomy cardiogenic shock (PCS) remains controversial in the absence of guidelines.

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass —A Vettath Modification

Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.

Effects on the renal artery blood flow during the intra-aortic balloonpumping was used

The effects of intra-aortic balloon pumping(IABP) on hemodynamic parameters inthe kidney were studied. The pulse produced by pumping activated the renal nervoussystem and reduced the renal vascular resistance. Therefore, the reduction of the renalvascular resistance is an important reason for the increase the renal blood flow duringintra-aortic balloon pumping.

Continuous internal counterpulsation as a bridge to recovery in acute and chronic heart failure

Cardiac recovery from cardiogenic shock(CS) and end-stage chronic heart failure(HF) remains anoften insurmountable therapeutic challenge. The counterpulsation technique exerts numerous beneficial effects on systemic hemodynamics and left ventricular mechanoenergetics, rendering it attractive for promoting myocardial recovery in both acute and chronic HF. Although a recent clinical trial has questioned the clinical effectiveness of short-term hemodynamic support with intra-aortic balloon pump(IABP, the main representative of the counterpulsation technique) in CS complicating myocardial infarction, the issue remains open to further investigation. Moreover, preliminary data suggest that long-term IABP support in patients with end-stage HF is safe and may mediate recovery of left- or/and right-sided cardiac function, facilitating long-term weaning from mechanical support or enabling the application of other permanent, life-saving solutions. The potential of long-term counterpulsation could possibly be enhanced by implementation of novel, fully implantable counterpulsation devices.

Factors influencing outcomes of intra-aortic balloon counterpulsation in elderly patients

Background Intra-aortic balloon counterpulsation （IABP） is a mechanical cardiac-assist device that is used for cardiac support. There are no published reports about the use of IABP in elderly Chinese patients, especially for those over 80 years old. The aim of this study was to describe the clinical outcomes, influencing factors, and complications in patients 〉80 years old and requiring IABP. Methods We performed a retrospective study of 134 consecutive patients who received IABP therapy. Based on age, we defined two groups; those 〉80 years old and those 〈80 years old. Results The overall mortality was 41.8%. Patients -〉80 years old had higher mortality rates than those 〈80 years old （47.9% vs. 30.2%）. Patients 〉80 years old had fewer successful revascularizations （45.8%） and more pulmonary infections （47.9%） than patients 〈80 years old （60.3% and 30.2%, respectively）; these differences were statistically significant. The most common non-cardiac complication was pulmonary infection. Cardiogenic shock and pulmonary infection were risk factors for all-cause, in-hospital mortality, whereas revascularization success was a negative risk factor for the -〉80 years old patients. Conclusions IABP may be successfully and safely employed in patients 〉80 years old, having severe heart disease, with few complications. Patients 〉80 years old who need IABP therapy are less likely to have a successful revascularization and are more likely to develop pulmonary infections than patients 〈80 years old.

主动脉内球囊反搏置管评估与护理管理的最佳证据总结

目的检索、评价并总结主动脉内球囊反搏(intra-aortic balloon pump counter pulsation,IABP)的置管评估与护理管理相关证据,为临床实践提供循证依据。方法按照“6S”模型,系统检索数据库、网站中关于IABP应用及护理的所有临床决策、指南、证据总结、专家共识、系统评价等,检索时限为建库至2023年1月。由2名研究者对相关文献进行独立筛选,并采用澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心研发的评价工具及临床指南研究与评价系统Ⅱ(appraisal of guidelines for research and evaluationⅡ,AGREEⅡ)对文献质量进行评价,并结合专业判断提取证据及归纳总结。结果共纳入17篇文献,包括2篇临床决策、2篇证据总结、8篇指南及5篇专家共识。通过对纳入文献的证据进行提取与整合,最终从IABP置入评估、有效触发、管路管理、临床监测、并发症管理、撤机、健康教育这7个方面汇总了32条最佳证据。结论该研究总结了IABP的应用及护理最佳证据。护理管理者及护士可结合患者意愿及临床情境选择并应用证据,制定科学的IABP管理方案,以保障患者生命安全。

Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

Background： Previous studies showed that patients with cardiogenic shock （CS） from ST-elevation acute myocardial infarction （STEMI） supported by intra-aortic balloon pump （IABP） before primary percutaneous coronary intervention （PCI） decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PC1 and its association with major adverse cardiac and cerebrovascular events （MACCEs）. Methods： Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014% who were treated with 1ABP and PCI. The patients were divided into two groups： Group A in whom IABP received before PCI （n = 106） and Group B in whom IABP received after PCI （n = 112）. We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE. Results： Most baseline characteristics were similar in patients between the two groups. However, patients received 1ABP before PCI were associated with a delay of door-to-balloon time （DBT） and higher troponin I level （P 〈 0.05）. However, myocardial perfusion was significantly improved in patients treated with IABP before PCI （P 〈 0.05）. Overall, IABP support before PCI was not associated with significantly lower risk of MACCE （P 〉 0.05）. In addition, risk of all-cause mortality, bleeding, and acute kidney injury （AKI） was similar between two groups （P 〉 0.05）. Multivariate analysis showed that DBT （odds ratio [OR] 2.5, 95% confidence interval [C/] 1.1-4.8, P=0.04）, lABP support after PCI （OR 5.7, 95% Cl 2.7-8.4, p〈0.01）, and AKI （OR 7.4, 95% CI 4.9 10.8, P- 0.01） were the independent predictors of mortality at 12-month follow-up. Conclusions： Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support before PCI does not confer a 12-month clinical benefit when used for STEMI with CS.

Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction

Background:There are few reports of peri-operative application of intra-aortic balloon pumping(IABP)in patients with coronary artery disease(CAD)and different grades of left ventricular dysfunction.This study aimed to analyze the early outcomes of perioperative application of IABP in coronary artery bypass grafting(CABG)among patients with CAD and left ventricular dysfunction,and to provide a clinical basis for the peri-operative use of IABP.Methods:A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014.Patients were assigned to an IABP or non-IABP group according to their treatments.Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality.Further subgroup analysis was performed on patients with severe(ejection fraction[EF]≤35%)and mild(EF=36%-50%)left ventricular dysfunction.Results:Out of 612 included subjects,78 belonged to the IABP group(12.7%)and 534 to the non-IABP group.Pre-operative left ventricular EF(LVEF)and EuroSCOREII·predicted mortality was higher in the IABP group compared with the non-IABP group(P<0.001 in both cases),yet the two did not differ significantly in terms of post-operative in-hospital mortality(P=0.833).Regression analysis showed that IABP implantation,recent myocardial infarction,critical status,non-elective operation,and postoperative ventricular fibrillation were risk factors affecting in-hospital mortality(P<0.01 in all cases).Peri-operative IABP implantation was a protective factor against in-hospital mortality(P=0.0010).In both the severe and mild left ventricular dysfunction subgroups,peri-operative IABP implantation also exerted a protective role against mortality(P=0.0303 and P=0.0101,respectively).Conclusions:Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.

Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

Background Outcomes in patients requiring coronary artery bypass graft （CABG） surgery have been improved with devices such as the intra-aortic balloon pump （IABP）.Good coronary collateral circulation （CCC） has been shown to reduce mortality in patients with coronary artery disease （CAD）.We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group （14 （50％） vs.4 （13％）,P=0.013）.Preoperative hemoglobin level （OR：0.752; 95％ CI,0.571-0.991,P=0.043）,chronic obstructive pulmonary disease （OR：6.731; 95％ CI,1.159-39.085,P=0.034） and poor CCC grade （OR：5.750; 95％ CI,1.575-20.986,P=0.008） were associated with post-CABG in-hospital mortality.Poor CCC grade （OR：4.853; 95％ CI,1.124-20.952,P=0.034） and preoperative hemoglobin level （OR：0.624; 95％ CI,0.476-0.954,P=0.026） were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

Efficacy and safety of intra-aortic balloon pump-assisted interventional therapy in different age groups of patients with acute coronary syndrome

Background Currently intra-aortic balloon pump （IABP） has been widely used in patients with acute coronary syndrome （ACS） who undergo percutaneous coronary intervention （PCI）. However, few studies have been done with regard to the clinical outcome and safety of IABP in assisting PCI in aged patients with ACS. The purpose of the present study was to evaluate the safety of tABP in different age groups of patients with ACS.Methods Data on 292 ACS patients who received IABP-assisted PCI in Shenyang General Hospital of People＇s Liberation Army were retrospectively analyzed. More specifically, the successful rate, mortality and complications associated with the treatment were compared between the senior （〉60 years old） and the non-senior （〈60 years old） groups of patients. Results The attack rate of non-ST segment elevation ACS was significantly higher in the senior group than in the non-senior group （38.8% vs 21.1%, P 〈0.01）. The incidence of the IABP-associated complications was not significantly different between both groups （P 〉0.05）.Conclusion The clinical outcome and safety of IABP-assisted PCI in the elderly patients were comparable to that for the non-elderly patients.

增强型体外反搏技术在慢性心力衰竭治疗中的应用研究

目的:研究增强型体外反搏技术用于治疗慢性心力衰竭的效果。方法:选取2020年10月至2021年10月山东省临沂市中心医院心血管内科收治的80例慢性心力衰竭患者,随机分为试验组和对照组。对照组给予单纯抗心衰药物治疗,试验组在上述药物治疗的基础上进行增强型体外反搏治疗,两组均治疗4周。对比治疗前后两组患者的左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、脑利钠肽前体(NT-proBNP)水平、6分钟步行距离。结果:治疗后,试验组患者血清NT-proBNP的水平低于对照组患者,LVEF高于对照组患者,LVEDD小于对照组患者,6分钟步行距离长于对照组患者,差异有统计学意义(P<0.05)。结论:应用增强型体外反搏技术治疗慢性心力衰竭的临床效果显著,可有效降低患者血清NT-proBNP的水平,使其LVEDD缩小,LVEF增加,活动能力增强,从而可提高其生活质量,改善其预后,值得推广应用。

Thrombocytopenia in patients of acute coronary syndrome with intra-aortic balloon pumping placement

Background Thrombocytopenia is a common complication of IABP. Until now,there is no unified conclusions about the incidence,characteristics,risk factors and the prognosis of IABP related thrombocytopenia.Methods In this study,the data of patients with ACS undergoing PCI and IABP were retrospectively analyzed.All enrolled patients were divided into thrombocytopenia group and non-thrombocytopenia group according to the occurrence of thrombocytopenia after insertion of IABP. The baseline data of the two groups were compared,and the possible risk factors of thrombocytopenia and their impact on prognosis were analyzed by chi-square test and logistic regression analysis. Results Sixty-two patients were enrolled in this study. The rate ofIABP associated thrombocytopenia was 25.8%(16/62)of all patients. Older agewas an independent risk factor of IABP associated thrombocytopenia(OR:3.625;95% confidence interval:1.016-12.935;P=0.047). The incidence of TIMI bleeding events was higher in thrombocytopenia group[75.0%(12/16)vs. 43.5%(20/46),P=0.042]. The rate of in-hospital death was similar between the two groups[18.8%(3/16)vs. 17.4%(8/46),P=1.0]. Conclusion IABP associated thrombocytopenia occurs in 25.8% of patients with ACS undergoing PCI and correlates with increased TIMI bleeding events. Older age may predict IABP associated thrombocytopenia.

Superior mesenteric artery embolism as a fatal complication of intra-aortic balloon pump: A case report and literature review

INTRODUCTION The intra-aortic balloon pump(IABP)is commonly used as a cardiac assist device in various clinical situations,including cardiogenic shock,mechanical complications of acute myocardial infarction,high risk percutaneous coronary interventions(PCI),coronary artery bypass graft surgery and refractory unstable angina,etc.However,like other invasive devices,the use of IABP has been associated with some complications.The most frequently reported complications are hemorrhage and limb ischemia.Rare complications include infection,arterial perforation,aortic dissection and thrombocytopenia and bowel infarction.Arterial embolism of internal organs is a rare but fatal complication of IABP therapy.Sirbu et al.reported that 59%of patients who developed ischemic vascular complications due to IABP died1.

Clinical significance of intra-aortic balloon pumping on no-reflow phenomenon of primary percutaneous coronary intervention for acute myocardial infarction

Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.

Application of intra-aortic balloon pumping on no-reflow phenomenon in primary PCI for STEMI

Background To investigate the effect of intra-aortic balloon pumping （IABP） on no-reflow phenomenon primary percutaneous coronary intervention （PCI） for ST-Elevation Myocardial Infarction （STEMI）. Methods Clinical data of 22 acute myocardial infarction patients after PCI with angiographic no-reflow phenomenon were retrospectively analyzed between January 2006 and December 2009.12 patients underwent IABP, other 10 patients as control group. We observed difference of cardiac structure, brain natriuretic peptide （BNP） and ventricular systolic function between two group, as well as cardiac injury markers （MYO,CK-MB, cTnI） in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions. In addition, cardiac structure and ventricular systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD）, left ventricular ejection fraction （LVEF） was evaluated after 10 days, 3 months,6 months Finally, statistics was used to analysis the data. Results The several vasoactive substances as well as cardiac injury markers and LAMD, LVMD, LVEF of 10 days, 3 months, 6 months of IABP group were significant difference with control group significant difference （P 〉 0.0 PCI with angiographic no-reflo （P 〈 0.05）. 5）. Conclusions w phenomenon, BNP targets of IABP group compared with the control group no IABP has effects on prognosis in STEMI patients who performed which is conducive to recovery of heart function.

A comparative analysis of intra-aortic balloon pump in off-pump patients undergoing coronary artery bypass grafting at different perioperative stages

Background Intra-aortic balloon pump （IABP） has been widely used at present. We can use it at different stages of perioperative period in off-pump coronary artery bypass grafting （CABG）. However, when to used it was seldom confirmed. Methods From January 2008 to June 2012, the 89 coronary heart disease （CHD） patients accepted implantation of IABP at different stages of off-pump CABG, preoperative and postoperative ventricular systolic function, left ventricular remodeling situation and the changes of myocardial enzymes were evaluated. Results All the patients had left heart insufficiency and muhivessel disease. Their postoperative left ventricular systolic function and ventricular remodeling were significantly improved while myocardial enzymes decreased with preoperative interventional implantation of IABP. The perioperative mortality was 7.86% （7/89）. No patients had complication of IABP. Conclusion Earlier IABP implantation at preoperation is useful to improve heart function, improve the tolerability of surgery, reduce the incidence of postoperative low cardiac output syndrome （LCOS） and decrease the mortality.

主动脉内球囊反搏术临床应用(附64例报告)

目的 研究主动脉内球囊反搏术(IABP)在急性心肌梗死(AMI)并发心源性休克患者临床运用效果。方法64例AMI伴心源性休克患者,在内科治疗的基础上进行IABP治疗。机器为Datascope system97E型反搏仪,均采用40ml型球囊导管,反搏持续时间为24～144h,经在IABP支持下,64例中62例进行急诊经皮冠状动脉成形术(PTCA)和支架术,2例进行急诊冠状动脉旁路移植术(CABG)。结果 64例患者中死亡18例,病死率为29.7％。结论 IABP支架下,积极进行血管重建治疗方能降低病死率。

年龄≥80岁和年龄<80岁的急性ST段抬高型心肌梗死患者主动脉内球囊反搏支持下直接经皮冠状动脉介入治疗预后的对比研究

目的:对比评价年龄≥80岁(老老年)和<80岁(中老年)因ST段抬高型心肌梗死(STEMI)而直接经皮冠状动脉(冠脉)介入治疗(PPCI)并需主动脉内球囊反搏(IABP)辅助支持患者的预后。方法:回顾分析我院2004-01至2015-12因STMEI而行PPCI,并需IABP支持患者的临床、冠脉造影和随访资料。排除标准为术前合并心原性休克、机械并发症和非ST段抬高急性冠脉综合症的患者。将患者分为老老年组(≥80岁,n=51)和中老年组(<80岁,n=237)。研究的主要终点包括PPCI术后1个月、1年及2年的死亡和术后1个月的主要不良心脑血管事件(MACCE,包括由死亡、心原性休克、新的或加重的心力衰竭、再次心肌梗死和卒中等组成的复合事件)。使用Cox比例风险模型分析致各终点事件的独立预测因子。结果:老老年组比中老年组术后1个月的MACCE发生率显著增加(41.2%vs 24.5%,P=0.029),其中卒中事件的发生率显著增加(9.8%vs 0.8%,P<0.001)。老老年组与中老年组术后1个月(17.6%vs 15.2%)和1年死亡率(25.5%vs 16.9%)比较差异均无统计学意义(P>0.05),但至术后2年时死亡率显著增高(35.3%vs 20.7%,Log-rank P=0.037)。术后心肌梗死溶栓治疗临床试验(TIMI)血流<3级是MACCE的强独立预测因子(HR=3.41,95%CI:2.09~5.56,P<0.001),均是各时间点死亡的最强独立预测因子(1个月:HR=9.51,95%CI:5.23~17.29;1年:HR=7.24,95%CI:4.13~12.69;2年:HR=5.85,95%CI:3.45~9.94;P均<0.001)。年龄≥80岁对各终点事件均无显著的预测效应。结论:老老年患者术后2年死亡率显著增高;术后1个月MACCE显著增高,主要为卒中事件显著增加。年龄≥80岁对各终点事件均无显著的预测效应。