高龄老人急性冠脉综合征的冠脉特点及临床分析

目的 研究高龄老人急性冠脉综合征（acute coronary syndrome，ACS） 的冠状动脉特点、与危险因素的关系及治疗现状。 方法 比较536 例≥ 80 岁ACS 患者与568 例60-70 岁ACS 患者的临床资料、冠状动脉病变特点以及治疗现状，按照冠状动脉病变支数分组，分析病变支数与危险因素的关系。 结果 ≥ 80 岁组，收缩压、空腹血糖、血肌酐水平明显增高（P ＜0.01），合并高血压、糖尿病、脑卒中以及慢性肾功能不全比例增高（P ＜0.05），多支病变、左主干、前降支和右冠状动脉病变增多（P ＜0.01），阿司匹林和氯吡格雷应用普及，β 受体阻断剂和ACEI/ARB 应用率下降（P ＜0.01）。在0、1、2 支及多支病变组，心率、收缩压、空腹血糖、血肌酐及肾小球滤过率差异显著（P ＜ 0.01）。随着病变支数增多，患者左主干、前降支、回旋支、右冠状动脉受累的比例增高（P ＜ 0.01），严重狭窄和完全闭塞的比例增高（P ＜ 0.01）。 结论 高龄ACS 患者病变复杂、合并疾病多，心率、收缩压、空腹血糖、血肌酐水平是高龄老人ACS 的危险因素，与病变支数相关。

Characteristics of coronary artery in advanced age patients with acute coronary syndrome

Objective To study the characteristics of coronary artery in advanced age patients with acute coronary syndrome （ACS）, the relation of ACS with its risk factors, and its management. Methods 536 ACS patients at the age ≥ 80 years and 568 ACS patients at the age of 60-70 years were included in this study. Their clinical data characteristics of coronary artery and management were compared. The patients were divided in 4 groups according to the number of stenosis arteries. Relation of the number of stenosis arteries with risk factors was analyzed. Results The systolic blood pressure（SBP）, fasting blood glucose （FBG）, and serum creatinine levels, the proportion of complications including hypertension, diabetes mellitus（DM）, stroke and chronic renal insufficiency, and the number of lesions in multi-vessels, left main branch（LM）, left anterior descending branch（LAD）, right coronary artery（RCA） were significantly higher in patients at the age ≥ 80 years （P 〈 0.01）. Aspirin and clopidogrel were commonly used while β receptor blocker and angiotensin-converting enzyme inhibitor（ACEI）/ angiotensin receptor blocker（ARB） were less used in treatment of the patients（P 〈 0.01）. The heart rate（HR）, SBP, FBG, serum creatinine（SCR） and estimated glomerular filtration rate （eGFR） were significantly different in the 4 groups. The stenosis proportion of LM, LAD, left circumflex branch（LCX） and RCA, and the proportion of severe stenosis and total occlusion increased with the number of stenosis branches （P 〈 0.01）. Conclusion Lesions of coronary artery in advanced age ACS patients are complicated and accompany with many diseases. HR, SBP, FBG, SCR and eGFR are the risk factors for ACS and related with the number of stenosis arteries.