老年无保护左主干病变介入治疗的临床疗效分析  

Clinical Outcomes of Unprotected Left Main Coronary Artery Disease Percutaneous Coronary Intervention in Elderly Patients

作　　者：刘圣文 胡奉环 陈珏 窦克非[1] 杨伟宪 吴永健[1] 杨跃进[1] 徐波[2] 乔树宾[2] LIU Sheng-wen;HU Feng-huan;CHEN Jue;DOU Ke-fei;YANG Wei-xian;WU Yong-jian;YANG Yue-jin;XU Bo;QIAO Shu-bin(Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,China;Catheterization Laboratories,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]国家心血管病中心,中国医学科学院,北京协和医学院,阜外医院心内科,北京市100037 [2]国家心血管病中心,中国医学科学院,北京协和医学院,阜外医院介入导管室,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第4期4072-4075,共4页Molecular Cardiology of China

摘　　要：目的分析老年(≥65岁)无保护左主干冠状动脉病变(unprotected left main coronary disease,ULMCAD)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)的疗效。方法2004年1月至2015年12月,在阜外医院行ULMCAD-PCI治疗的患者3960例,其中1397例年龄≥65岁(老年组),2563例年龄<65岁(非老年组)。临床终点事件包括3年随访时主要不良心脏事件(major adverse cardiovascular event,MACE)、全因死亡、心肌梗死、再次血运重建的发生率。结果与非老年组相比,老年组患者的MACE(16.2%∶13.5%,P=0.002)、全因死亡(6.1%∶2.3%,P<0.0001)、心肌梗死(6.1%∶3.5%,P<0.0001)、再次血运重建(7.7%∶9.6%,P=0.04)明显升高。应用倾向性评分校正后,两组之间的MACE(危险比[HR]:1.16,95%可信区间[CI]:0.93~1.53,P=0.18)以及再次血运重建(HR:0.81,95%CI:0.61~1.06,P=0.13)无统计学差异。然而,全因死亡(HR:2.08,95%CI:1.35~3.22,P=0.0007)和心肌梗死(HR:1.73,95%CI:1.16~2.56,P=0.0056)在老年组患者中发生率更高。结论3年随访结果表明,老年无保护左主干冠状动脉疾病患者介入治疗的临床预后劣于非老年ULMCAD患者。Objective To analyze the efficacy of percutaneous coronary intervention(PCI)in elderly patients(age≥65 years)with unprotected left main coronary artery disease(ULMCAD)through comparing with non elderly patients(age<65 years old).Methods From January 2004 to December 2015,there were 3960 patients undergoing ULMCAD PCI in Fuwai hospital,including 1397 cases were the elderly and 2563 were non elderly patients.The clinical outcome included the incidence of major adverse cardiac events(MACE)(all-cause death,myocardial infarction(MI),and revascularization),all-cause death,MI,revascularization at 3-year follow-up.Results Compared with the non elderly patients,the elderly patients had significantly higher MACE(16.2%vs.13.5%,P=0.002),all-cause death(6.1%vs.2.3%,P<0.0001),MI(6.1%vs.3.5%,P<0.0001),lower revascularization(7.7%vs.9.6%,P=0.04),respectively.After propensity score adjustment,no statistically significant differences for MACE was noted(hazard ratio[HR]:1.16,95% confidence interval[CI]:0.93 to 1.53,P=0.18)between two groups,as well as revascularization(HR:0.81,95%CI:0.61 to 1.06,P=0.13).However,the incidence of all-cause death(HR:2.08,95%CI:1.35 to 3.22,P=0.0007)and MI(HR:1.73,95%CI:1.16 to 2.56,P=0.0056)were higher in elderly patients.Conclusion The 3-year follow-up results show that the prognosis of elderly patients with ULMCAD-PCI is worse than that of non elderly patients.

关 键 词：老年患者 无保护左主干冠状动脉疾病 经皮冠状动脉介入 

分 类 号：R541[医药卫生—心血管疾病]