高龄老年冠心病患者介入治疗的疗效及并发症分析

目的 分析高龄老年冠心病（CAD）介入治疗的特点和近、远期疗效及并发症情况.方法 回顾性分析2009-01～2010-06完成的122例经皮冠状动脉介入治疗（PCI）的老年患者,不包括急性ST段抬高心肌梗死（STEMI）的临床资料,统计、分析和比较高龄老年组（≥75岁）与年轻老年组（60～〈75岁）的临床及冠脉病变特点,不宜或未能置入支架以及术中、术后发生不良事件的比例.结果 高龄老年组（48例）合并高血压、糖尿病的比例高于年轻老年组（74例）,差异有统计学意义（P〈0.01）;高龄老年组多见冠脉多支病变和复杂病变（P〈0.01）;高龄老年组即刻治疗成功率（95.8%）与年轻老年组（98.6%）比较差异无统计学意义（P〉0.05）;住院期间并发症及远期随访严重不良心脏事件高龄老年组（12.5%）均高于年轻老年组（5.4%）,除1例死亡病例外,并发症经积极处理后均痊愈.结论 高龄老年CAD患者常有重要脏器的功能减退,其冠脉病变的特点常为多支和复杂病变,PCI术中、术后不良事件的发生率虽然较高,但并发症经积极处理后均痊愈,预后良好,PCI是治疗高龄老年CAD患者不可或缺的重要手段.

Effect and complications of percutaneous coronary intervention in patients with coronary artery disease in elderly patients

Objective To explore the therapeutic effect and complication of percutaneous coronary intervention in patients with coronary artery disease over 75 years old. Methods One hundred and twenty-two patients underwent PCI from January 2009 to June 2010 were divided into the elderly group （age≥75 years）and the younger group （60 〈 age 〈 75 years）. The angiographic characteristics and the incidence of major adverse events such as ventricular fibrillation, angina pectoris during following up were analyzed and compared between the two groups. Results There were 48 patients in the elderly group and 74 patients in the younger group. The rates of hypertension, diabetes, hyperlipoidemia in elderly group were much higher than those in younger group （ P 〈 0. 01 ）. The elderly patients were more likely to have multi-vessels lesions and complex lesions （P 〈 0.01 ）. There was no significant statistic difference in the achievement rate of immediate treatment between the elderly group（95.8% ） and the younger group （98.6%） （P 〉0. 05）. And the in-hospital outcomes and 30 days follow-up revealed the incidence of major adverse events were higher in the elderly group （12.50%） than those in the younger group （5.4%）, but the difference between those two groups is not significant （P 〉 0. 05）. Conclusion The patients with coronary artery disease over 75 years old are more commonly accompanied by multi-organic dysfunction,their coronary arteries tend to have multi-vessel lesions and complex lesions. The incidence of major adverse events during PCI is higher in the elderly patients. But complications are healed after active treatment, the prognosis is good. PCI treatment is indispensable important means in elderly patients with coronary artery disease.