老年冠状动脉慢性完全闭塞患者的临床特征分析

Clinical characteristics of coronary chronic total occlusion in the elderly

摘要:

目的 总结并探讨老年冠状动脉慢性完全闭塞（CTO）冠心病患者的临床、影像学和经皮冠状动脉介入治疗（PCI）的特点。方法 入选1995年1月至2014年12月入住沈阳军区总医院心内科行PCI的CTO患者3 957例，其中老年组1452例（36.7%）。结果 老年组稳定型心绞痛比例低于非老年组，而不稳定型心绞痛患者比例高于非老年组，差异均具有统计学意义（P＜0.05）。老年组高血压和心力衰竭比例高于非老年组，差异均具有统计学意义（均P＜0.001）。老年组冠心病监护病房CCU住院天数和总住院天数均高于非老年组（P＜0.001）。老年组多支血管病变比例，左主干CTO比例，绝对性、截然闭塞（刀切状）、长度≥15mm、直径≤2.5mm及桥侧支CTO比例均高于非老年组（P＜0.001）。老年组CTO靶血管成功率低于非老年组（P＜0.05），完全血运重建比例也低于非老年组（P＜0.001）。结论 老年CTO病变患者具有不稳定型心绞痛、高血压、心力衰竭和多支病变所占比例偏高的特点，且病变程度复杂，增加了介入治疗的难度。

Abstract:

Objective To analyze and summarize the characteristics of clinical, imaging and percutaneous coronary intervention (PCI) data in the elderly with chronic total occlusion (CTO) of the coronary artery. Methods The clinical data of 3 957 patients (including 1 452 cases ≥65 years old, 36.7%) with CTO verified by coronary angiography admitted in our department from January 1995 to December 2014 were collected and analyzed retrospectively. Results The incidence of stable angina was significantly lower in the elderly group than in the non-elderly group, but that of unstable angina was higher (both P＜0.05). The elderly group had more patients suffering from hypertension and heart failure than the non-elderly group (both P＜0.001). The duration at cardiac care unit (CCU) and total length of hospital stay were longer in the former than in the latter group (both P＜0.001). The ratios of patients with multi-vessel lesion, left main coronary artery CTO, absolute occlusion, stump missing, CTO ≥15mm in length, CTO ≤2.5mm in diameter and bridging collaterals were significantly higher in the elderly group than in the non-elderly group (P＜0.001). The successful rate of PCI and complete revascularization was lower in the elderly than in the non-elderly group (P＜0.05). Conclusion The elderly CTO patients have higher rates of hypertension, heart failure and multi-vessel lesion, and are characterized by complex lesions and difficulty to PCI.