75岁及以上急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗状况及预后  

Status and prognosis of acute ST-elevation myocardial infarction in elder patients 75 years of age or older after percutaneous coronary intervention

作　　者：谭静[1] 张迎花[1] 司瑾[1] 左雪冰 李静[2] TAN Jing;ZHANG Ying-Hua;SI Jin;ZUO Xue-Bing;LI Jing(Department of Cardiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Geriatric Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院心脏内科,北京100053 [2]首都医科大学宣武医院老年医学科,北京100053

出　　处：《中华老年多器官疾病杂志》2022年第8期597-601,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的分析≥75岁急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)的状况及预后。方法回顾性分析2009年4月至2018年12月首都医科大学宣武医院心脏内科收治的425例≥75岁急性STEMI患者的临床资料,根据住院期间治疗方式分为急诊PCI组112例、择期PCI组80例和保守治疗组233例。收集患者基本临床资料、住院期间治疗方式及并发症发生情况等,每1~3个月进行门诊或电话随访观察预后,随访至2019年12月。采用SPSS 26.0统计软件进行数据分析。采用多因素logistic回归分析影响治疗策略选择的因素。绘制Kaplan-Meier生存曲线,采用log-rank检验分析各组生存率差异。结果≥75岁急性STEMI患者行急诊冠状动脉造影和急诊PCI的比例分别为31.5%(134/425)和26.4%(112/425)。多因素logistic回归分析显示发病至就诊时间(OR=0.841,95%CI 0.792~0.893;P<0.001)和心功能Killip≥Ⅱ级(OR=0.440,95%CI 0.238~0.814;P<0.01)是影响急诊PCI的独立因素;年龄(OR=1.259,95%CI 1.129~1.405;P<0.001)、肌酐清除率(OR=0.972,95%CI 0.952~0.993;P<0.01)和心功能Killip≥Ⅱ级(OR=2.958,95%CI 1.420~6.163;P<0.01)是影响择期PCI的独立因素。急诊PCI、择期PCI和保守治疗组院内全因死亡率分别为13.4%(15/112)、3.8%(3/80)和18.9%(44/233),保守治疗组全因病死率显著高于择期PCI组,差异有统计学意义(P<0.05)。择期PCI组心室颤动的比例显著低于急诊PCI组,差异有统计学意义[0.0%(0/80)和8.9%(10/112);P<0.05]。中位随访时间31(12,53)个月,保守治疗组累积生存率显著低于急诊PCI组和择期PCI组[44.6%(104/233)和71.4%(80/112),78.8%(63/80);均P<0.05]。结论≥75岁STEMI患者急诊PCI治疗比例较低,发病至就诊时间、高龄、心肾功能不全与患者治疗策略选择相关。接受PCI治疗的患者近期和远期存活率显著高于药物保守治疗者。Objective To analyze the status of percutaneous coronary intervention(PCI)and prognosis in patients aged 75 years or older with acute ST-elevation myocardial infarction(STEMI).Methods The clinical data of 425 acute STEMI patients aged≥75 years admitted to our hospital from April 2009 to December 2018 were retrospectively analyzed.According to their treatment during hospitali-zation,they were divided into emergency PCI group(n=112),elective PCI group(n=80)and conservative treatment group(n=233).Their basic clinical data,treatment during hospitalization and incidence of complications were collected.All patients were followed up regularly every 1-3 months by clinical visits or phone interview till December 2019.SPSS statistics 26.0 was used for data analysis.Multivariate logistic regression was used to analyze the factors influencing the clinical decision-making strategy.Kaplan-Meier survival curve was drawn,and log-rank test was employed to analyze the differences in survival rates among the groups.Results The rates of emergency coronary angiography and emergency PCI were 31.5%(134/425)and 26.4%(112/425),respectively for the acute STEMI patients aged≥75 years.Multivariate logistic regression analysis revealed that symptom-onset-to-treatment time(OR=0.841,95%CI 0.792-0.893;P<0.001)and initial Killip class≥Ⅱ(OR=0.440,95%CI 0.238-0.814;P<0.01)were independent influencing factors of emergency PCI;age(OR=1.259,95%CI 1.129-1.405;P<0.001),creatinine clearance rate(OR=0.972,95%CI 0.952-0.993;P<0.01)and initial Killip class≥Ⅱ(OR=2.958,95%CI 1.420-6.163;P<0.01)were independent factors for elective PCI.The in-hospital all-cause mortality was 13.4%(15/112),3.8%(3/80)and 18.9%(44/233),respectively in the emergency PCI,elective PCI and conservative treatment groups,with significant differences among them(P<0.05).The incidence of ventricular fibrillation was statistically lower in the elective PCI group than the emergency PCI group[0.0%(0/80)vs 8.9%(10/112),P<0.05].During a median follow-up of 31(12~53)months,the cumu

关 键 词：老年人 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 病死率 

分 类 号：R541[医药卫生—心血管疾病]