高龄急性冠脉综合症患者急诊介入治疗对临床预后的影响

Effect of emergency percutaneous coronary intervention on prognosis in the very elderly with acute coronary syndrome

摘要:

目的 研究高龄老年急性冠脉综合征患者（ACS）行急诊经皮冠状动脉介入治疗（PCI）的安全性和有效性。方法 高龄老年（≥80岁）ACS患者37例，分为PCI组（n＝16）和对照组（n＝21），比较两组患者基本临床情况和住院期间及随访30d时主要不良心脑血管事件（MACCEs）的发生率。结果 两组患者基线特征无差异；冠状动脉造影结果显示PCI组患者完全闭塞病变占50%以上，几乎所有患者均成功植入支架治疗。住院期间，PCI组和对照组患者MACCEs发生率分别为37.50%和28.57%（P＝0.682），主要为死亡、心力衰竭和非致命性出血；随访30d时，PCI组和对照组MACCEs发生率分别为15.79%和13.33%（P＝0.578），主要包括死亡和因心力衰竭或上消化道出血而再住院。结论 ≥80岁的高龄ACS患者行PCI治疗是安全有效的，且并不增加MACCEs发生率；同时支架选择宜个体化。

Abstract:

Objective To investigate the safety and efficacy of emergency percutaneous coronary intervention (PCI) in the very elderly with acute coronary syndrome (ACS). Methods A total of 37 patients (≥80 years) who were diagnosed as ACS after admission in our department from January 2009 to June 2012 were subjected in this study. They were divided into two groups according to undergoing emergency PCI or not: PCI (n＝16) and control (n＝21) groups. The general clinical conditions and the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) in hospitalization duration and during the 30 days follow-up were compared between the two groups. Results No significant difference was seen with respect to baseline characteristics. Coronary arteriography indicated that more than 50% patients had lesions of chronic total occlusion, all patients of this group underwent PCI with drug eluting stenting. During hospitalization, the incidences of MACCEs including all-cause death, heart failure and nonfatal bleeding in PCI and control groups was 37.50% and 28.57%, respectively(P＝0.682). In 30 days follow-up, there was also no significant difference in the incidences of MACCEs between the two groups (15.79% vs 13.33%, P＝0.578), including death and rehospitalization due to heart failure or upper gastrointestinal hemorrhage. Conclusion For the very elderly with ACS, PCI with stenting is safe and efficient, and does not increase MACCEs incidence. Furthermore, the choice of stent should be individualized.