高龄急性非ST段抬高型心肌梗死患者冠状动脉介入治疗的临床疗效研究  

Clinical efficacy of PCI in very old acute NSTEMI patients

作　　者：梁长在 王申 韩雅蕾[1] 高炬[1] 曲涛[1] 陈传军[1] 翟东东 刘宏斌[2] 张萌[1] Liang Changzai;Wang Shen;Han Yalei;Gao Ju;Qu Tao;Chen Chuanjun;Zhai Dongdong;Liu Hongbin;Zhang Meng(Department of Cardiology,Aerospace Central Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院心脏医学部,北京100049 [2]解放军总医院第二医学中心心血管内科

出　　处：《中华老年心脑血管病杂志》2021年第11期1154-1157,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：航天中心医院青年创新基金(2020QN01);首都临床特色应用研究项目(Z181100001718065)。

摘　　要：目的分析高龄急性非ST段抬高型心肌梗死(NSTEMI)患者的临床特征,评估PCI的安全性及有效性。方法回顾性纳入2017年1月~2020年12月于航天中心医院心脏医学部住院的高龄(≥80岁)NSTMI患者139例,分为PCI组72例和保守治疗组67例,分析患者临床特征,比较2组临床结局。结果PCI组肌酐、eGFR≤30 ml/(min·1.73 m^(2))及使用低分子肝素比例明显低于保守治疗组,eGFR及使用阿司匹林比例明显高于保守治疗组(P<0.05),2组全球急性冠状动脉事件注册评分均>140分,但无统计学差异(P>0.05)。PCI组院内病死率、出院随访1个月复合终点事件发生率及病死率明显低于保守治疗组(P<0.05)。调整混杂因素后多因素分析显示,年龄、Killip分级Ⅲ~Ⅳ级、cTnI、肌酐是高龄NSTEMI患者全因死亡的危险因素(95%CI:0.805~0.989,P=0.030;95%CI:1.049~2.521,P=0.030;95%CI:0.990~1.063,P=0.004;95%CI:0.938~1.023,P=0.013)。结论对于高龄NSTEMI患者,PCI治疗相对于药物保守治疗可显著降低死亡事件及临床复合终点事件的发生。Objective To assess the safety and efficacy of PCI by analyzing the clinical characteristics of very old acute NSTEMI patients.Methods One hundred and thirty-nine very old(≥80 years)acute NSTEMI patients were divided into PCI group(n=72)and conservative treatment group(n=67).Their clinical characteristics were analyzed and their clinical outcomes were compared.Results The serum creatinine level,eGFR≤30 ml/min·1.73 m^(2) and low molecular heparin application ratio were significantly lower while the eGFR and aspirin application ratio were significantly higher in PCI group than in conservative treatment group(P<0.05).No significant difference was detected in GRACE score>140 between the two groups(P>0.05).The inhospital mortality and incidence of clinical endpoint events were significantly lower in PCI group than in conservative treatment group during the 1-month follow-up period after discharge(P<0.05).Multivariate logistic regression analysis showed that age,KillipⅢ-Ⅳ,cTnI and creatinine were risk factors for all-cause death in very old acute NSTEMI patients after adjustment for the confounding factors(95%CI:0.805-0.989,P=0.030;95%CI:1.049-2.521,P=0.030;95%CI:0.990-1.063,P=0.004;95%CI:0.938-1.023,P=0.013).Conclusion The mortality and incidence of clinical endpoint events are significantly lower in very old NSTEMI patients after PCI than after conservative treatmentt.

关 键 词：非ST段抬高型心肌梗死 经皮冠状动脉介入治疗 阿司匹林 肝素 低分子量 

分 类 号：R542.22[医药卫生—心血管疾病]