老年女性无保护左主干病变患者经皮冠状动脉介入术的长期疗效观察

Percutaneous coronary intervention for unprotected left main coronary artery disease in old females: a long-term study on clinical efficiency

摘要:

目的 探讨合并冠状动脉左主干（LMCA）病变老年女性患者经皮冠状动脉介入（PCI）术后的长期预后。方法 从1997年12月～2012年10月，共有302例女性患者在我院首次行冠状动脉造影提示LMCA并行PCI，其中≥65岁的老年女性156例，年龄（72.0±4.31）岁；＜65岁非老年女性146例，年龄（55.5±7.06）岁。两组成功PCI患者随访（42.0±19.3）个月，比较两组患者的临床基本特征、冠状动脉病变特点、PCI特点及随访结果。结果 老年组高血压和急性心肌梗死的比例较非老年组虽有增高的趋势，但差异无统计学意义。老年组的Syntax评分明显高于非老年组[（26.6±8.49） vs （23.5±9.10），P＜0.01]。老年组与非老年组PCI成功率均为100%，两组所采用手术术式、植入支架平均直径及长度，以及药物洗脱支架的比例均无明显差异。与非老年组相比较，老年组在总的主要不良心血管事件发生率、支架内血栓及全因死亡的发生率均无明显增加。结论 合并LMCA病变的老年女性患者接受PCI是安全的，通过强化抗血小板治疗、选择合理的手术策略可改善其长期预后。

Abstract:

Objective To investigate the long-term outcomes of percutaneous coronary intervention (PCI) in the old female patients with left main coronary artery (LMCA) disease. Methods A total of 302 female patients with LMCA disease who underwent PCI in our department from December 1997 to October 2012 were enrolled and retrospectively analyzed in this study. They were divided into the old group [≥65 years, with age of (72.0±4.31) years, n＝156] and non-old group [＜65 years, with age of (55.5±7.06) years, n＝146]. The time of follow-up was (42.0±19.3) months in both groups after successful angioplasty. The basic clinical and angiographic characteristics, immediate results of PCI and major adverse cardiac event (MACE) defined as target vessel revascularization, acute myocardial infarction, and sudden cardiac death were analyzed between 2 groups during follow-up. Results The ratio of patients with hypertension and acute myocardial infarction were higher in old group than in non-old group, but with no significant difference between them (P＞0.05). Compared with non-old group, the Syntax score of the old group was significantly higher [(26.6±8.49) vs (23.5±9.10), P＜0.01]. All procedures were successfully completed in all-patients in both groups. The procedural strategies, the length and diameter of stent in LMCA and the ratio of drug eluting stent implantation were not significantly different between two groups. Meanwhile, the rate of MACE, stent thrombosis and all cause death were not significantly different between two groups. Conclusion PCI can be performed in old female LMCA patients successfully and safely. Anti-platelet therapy and optimized procedures will improve the long-term clinical outcomes of PCI in old females with LMCA disease.