75岁以上老年冠心病患者的冠状动脉介入治疗  

The percutaneous coronary intervention in patients with coronary artery disease over 75 years old

作　　者：屈健[1] 项军[1] 赵勇[1] 何凌宇[1] 崔云惠[1] 张春香[1] 毕玉洁[1] 吴敏[1] 张艳玲[1] 徐卫东[1] 叶福林[1] 梅健[1] 万向荣[1] 

机构地区：[1]解放军第97医院,江苏徐州221004

出　　处：《东南国防医药》2007年第2期88-90,共3页Military Medical Journal of Southeast China

摘　　要：目的探讨75岁以上老年冠心病患者冠状动脉病变特点及其介入治疗(PCI)的安全性。方法回顾性分析2005年3月至2006年3月间43例行PC I的患者,统计、分析和比较≥75岁老年组与≤74岁年龄组的临床及冠脉病变特点,成功置入支架、不宜或未能置入支架而需外科搭桥以及术中、术后发生不良事件的比例。结果两组合并高血压、高血脂、糖尿病的比例基本相似,但≥75岁老年组(20例)患陈旧性心肌梗死、左心功能不全、陈旧性脑梗死和肾功能减退的比例[分别为25%比13%(P<0.05)、35%比8.7%(P<0.01)、25%比13%,、20%比4.3%(P<0.05)]高于≤74岁年龄组(23例);两组冠脉造影病变阳性率大致相似,但≥75岁老年组的冠脉病变多为多支病变、复杂病变(两组比较分别为50%比17.6%、74.3%比51.6%,(P<0.01),成功置入支架的比例前者显著低于后者(34.3%比58.1%,P<0.01);因多支病变或复杂病变不宜或未能置入支架而需外科搭桥的比例前者显著高于后者(35.7%比17.6%,P<0.01);PC I术中、术后不良事件发生率前者显著高于后者(30%比0,P<0.01)。结论≥75岁老年冠心病患者常有心、脑、肾功能减退,其冠脉病变的特点是常为多支和复杂病变,PC I术中、术后不良事件的发生率高。Objective To investigate the angiographic characteristics and safety of percutaneous coronary intervention（PCI） in patients with coronary artery disease over 75 years old. Methods 43 patients underwent PCI during the period from march 2005 to march 2006 were divided into the elder group （age≥75 years old） and the younger group （age≤74 years old）. The angiographic characteristics, immediate stenting success rate and the incidence of major adverse events such as ventricular fibrillation, angina pectoris during follow-up were analyzed and compared between the two groups. Results 20 patients were enrolled in the elder group and 23 patients were enrolled in the younger group. There were no statistical difference in proportion of hypertension, hyperlipidemia and diabetes mellitus between the two groups. Proportion of old-myocardial infarction, cardiac dysfunction, old- cerebral vascular infarction and kidney dysfunction were more commonly found in the elder group （25 % vs 13% ,P〈0.05;35 % vs 8.7% ,P〈0.01 ;25% vs 13%%,20% vs 4.3% ,P〈0.05）. The occurance rate of coronary artery lesions in angiography was found no difference. While multivessels lesions, complex lesions, no immediate stenting success rate and incidence of major adverse events were higher in the elder group than those in the younger group（50% vs 17.6% ,74.3% vs 51.6%, 35.7% vs 17.6%,30% vs 0,P^0.01）. Conclusion In patients ≥75 years old coronary arterial disease are more commonly accompanied by multiorganic dysfunction, their coronary arteries tend to have multivessels lesions and complex lesions . The incidence of major adverse events during PCI is higher in the elder patients .

关 键 词：冠状动脉疾病 经皮冠状动脉介入治疗 老年人 安全性 

分 类 号：R541.4[医药卫生—心血管疾病]