高龄老年心绞痛患者的介入治疗和外科手术治疗

目的 评价介入治疗(PCI)和外科手术(CABG)治疗老年(≥80岁)心绞痛患者的有效性和安全性。方法 回顾性分析4年间在莱比锡心脏中心连续就诊的老年心绞痛,接受PCI和CAN3治疗患者。观察终点为住院期间死亡、再次心肌梗死、再次血运重建。结果 共482例患者,分为PCI组281例,CABG组201例。糖尿病、高血压、肥胖症、既往心肌梗死史等在两组间无显著性差异。既往PCI、CABG史者在PCI组更多(20.6％ vs 8.0％,P<0.05:10.096 vs 2.0％,P<0.05);而手术组左主干、3支病变比例较高(1.1％ vs 7.5％,P<0.05;17.4％ vs 62.2％,P<0.05)。住院期间两组复合终点事件无差异(9.6％ vs 7.5％,P>0.05)。但外科手术死亡率稍高(3.2％ vs7.5％),有一定比例的手术并发症。结论 老年心绞痛病人,接受PCI或CABG治疗是可行的,住院期间两组终点事件无差异。

Interventional therapy and bypass surgery in octogenarians with angina pectoris

Objective To evaluate the safety and efficacy of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in treating octogenarians with angina pectoris. Methods Consecutive octogenarians with stable and unstable angina admitted to Leipzig Heart Center from January, 1997 to December, 2 000 were analyzed retrospectively. All patients enrolled were treated with PCI or CABG. Endpoint: death, re-infarction and repeat revascularization in hospital. Results A total of 482 patients were divided into PCI group with 281 patients and CABG group with 201 patients. The incidences of diabetes, hypertension and previous infarction were not significantly different between two groups. More patients with previous PCI or CABG were recorded in PCI group (20.6% vs 8.0% ,P<0.05;10.096 vs 2.0% ,P<0.05). The rates of left main artery lesion and triple vessel disease were higher in CABG group (1.1 % vs 7.5% ,P<0.05;17.4% vs 62.2% ,P<0.05). Combined endpoints were not significantly different between two groups(9. 6% vs 7. 5% , P>0. 05). The death rate was slightly higher in CABG group (3. 296 vs 7.5%) with some surgery complications. Conclusions There was no significant difference in the endpoint events in hospital between two groups. It is acceptable that octogenarian patients with angina can be treated with PCI or CABG.