老年冠心病患者植入药物洗脱支架的预后研究

目的 比较老年与非老年冠心病患者接受药物洗脱支架(DES)植入的预后,并比较老年冠心病患者不完全血运重建与完全血运重建预后的差异. 方法入选接受经皮冠状动脉介入治疗(PCI)并植入DES的患者,根据患者的年龄分为75～89岁组、60～74岁组和40～59岁组,并将60～89岁的患者分为完全和不完全血运重建两组,分别比较各组的临床特征及预后情况. 结果手术成功率75～89岁组、60～74岁组和40～59岁组间比较,差异无统计学意义(均P>0.05).75～89岁组的院内病死率高于其他两组(分别为1.5%与0.4%,0.1%,均P<0.05);随访期死亡和脑卒中发生率也高于其他两组(分别为3.1%与2.3%、0.7%;1.5%与1.3%、0.3%,P<0.01或P<0.05).Cox回归分析结果显示,影响60～74岁组和75～89岁组患者住院及随访期病死率增加的主要因素为血肌酐水平(OR=2.961,95%Ci为1.643～5.338,P<0.01)、年龄(OR=2.687,95%CI为1.329～5.434,P<0.01)、性别(OR=2.661,95%CI为1.376～5.145,P<0.01)、陈旧性心肌梗死(OR=2.041,95%CI为1.026～4.061,P<0.05)和多支冠状动脉病变(OR=1.735,95%CI为1.132～2.661,P<0.05).60～74岁组中,不完全血运重建组的病死率高于完全血运重建组(分别为1.5%和0.2%,P<0.05),多因素Logistic回归分析结果提示,血运重建(OR=0.307,95%CI为0.011～8.467,P>0.05)不是不完全血运重建患者住院病死率增加的因素. 结论 75～89岁组老年冠心病患者接受PCI及DES植入的预后较40～59岁组患者差.完全血运重建使老年冠心病患者获益更大,但不完全血运重建不影响患者远期预后.

Study on the prognosis of drug-eluting stent implantation in the elderly patients with coronary heart disease

Objective To evaluate the prognosis of drug-during stent (DES) implantation in elderly patients versus non-elderly patients, and to determine the clinical outcome of complete revascularization strategy versus incomplete revascularization strategy in elderly patients. Methods Patients who were treated with at least 1 DES in our hospital were enrolled in the study. They were divided into 3 groups: the elderly group (aged 75～89 years), the presenium group (age 60～74years) and the non-elderly group (aged 40～59 years). The patients aged 60～89 years were further divided into complete revascularization group and incomplete revascularization group according the Percutaneous interventional the rapy (PCI) strategy. Clinical characteristics, angiographical and interventional data were collected. Results The success rate of PCI procedure was 99.3% in elderly group(n=137), 98.7% in presenium group(n= 1006), and 99.3% in non-elderly group(n= 1031).There were no significant differences among the three groups(P>0.05). The in-hospital mortality was highest in the elderly group among the three groups (1.5%, 0.4%, 0.1%, P<0.05), but the in-hospital rates of re-infarction, repeated revascularization and stroke had no significant differences among the three groups (P>0.05). During follow-up, the rates of death and stroke were highest in the elderly group(3.1%, 2.3%, 0.7%, P<0. 01;1.5% , 1.3%, 0.3%, P<0.05, respectively),but the rates of re-infarction and repeated revascularization among the three groups had no significant differences (all P>0.05). By Cox regression analysis, serum creatinine (OR= 2.961,95%CI=1. 643～5.338,P<0.01), gender (OR=2.661,95%C1=1.376～5.145 ,P<0.01), age(OR=2.687,95%CI=1.329～5.434, P<0.01), multi-vessel disease(OR= 1.735,95 %CI= 1.132～2.661, P<0.05), and old myocardial infarction (OR = 2.041 ; 95% CI = 1.026～4.061; P<0.05) were the independent predictors for all-cause death in patients aged 60～74 years. The in-hospital mortality was higher in the incomplete revascularization group than in complete revascularization group in patients aged 60～74 years (1.4% vs. 0.2%, P<0.05). Multiple logistic regression analysis revealed that the incomplete revascularization strategy was not the independent predictor of in-hospital death (OR=0.307; 95%CI=0.011～8.467; P>0.05). Conclusions Although DES implanting is successfully procedured in presenium and elderly patients, it is associated with higher in-hospital mortality, especially in patients aged ≥75 years . Presenium and elderly patients are to be more benefit from complete revascularization strategy, but the incomplete revascularization strategy does not influence the long-term outcomes.