老年冠心病患者冠状动脉内支架置入术的临床评估

目的　评估老年冠心病患者的冠状动脉内支架置入术(支架术)的安全性和有效性。　方法　将我院123例年龄≥60岁(老年组)和265例年龄＜60岁(非老年组)已行支架术的冠心病患者的临床病灶特点、手术成功率、手术并发症及近、远期临床随访结果进行了回顾性对照分析。　结果　老年组在经皮冠状动脉腔内成形术（PTCA）的基础上行支架术总成功率与非老年组比较差异无显著性(96.7%与99.6%，Ｐ＞0.05)；老年组手术死亡率为1.6%（2/123），但与非老年组相比差异无显著性（Ｐ＞0.05），两组间冠状动脉血管、外周血管并发症无明显差异;老年组因冠状动脉扩张后发生急性血管闭塞或严重内膜撕裂而置入支架比例明显高于非老年组（23.7%与14.3%,Ｐ＜0.001）；老年组左主干病变比例明显高于非老年组（3.2%比0.3%,Ｐ＜0.001）。随访6～54个月，两组患者恶性心脏事件发生率无明显差异，但老年组患者血运重建率明显高于非老年组（16.3%与7.8%,Ｐ＜0.05）。　结论　随着PTCA及支架置入技术的日臻完善，老年患者行支架术的成功率与非老年患者无明显差异，均达国内先进水平，老年患者的围手术期死亡率、急性期并发症及长期临床疗效与非老年患者比较无明显差异，均与全国注册水平相似，因此支架术是治疗老年冠心病患者安全、有效的方法。

Clinical analysis of coronary stenting in elderly patients with coronary artery disease

Objective　To access the safty and efficacy of coronary stenting in elderly patients.Methods 123 patients aged ≥ 60 years(elderly group, 185 vessels) who underwent coronary stenting were compared with 265 patients aged <60 yesrs (non elderly group, 348 vessels) in clinical characteristics, successful rate, severe complications and the follow up results. Results Comparing the technical success 〔percutaneous transluminal coronary angioplasty (PTCA) + coronary stenting〕and the in hospital death rate (96.7% and 1,6% in the elderly group，99.6% and 0% in the non elderly group)，it showed no significant differences(Ｐ＞0.05); complication occurences in coronary artery and peripheral arteries between two groups did not show difference either. However, “bailout" stenting rate of the elderly group was higher than the non elderly group(23.7% vs 14.3%,Ｐ＜0.001). The proportion of main artery diseases in the left side in the elderly group was higher than that in the non elderly group (3.2% vs 0.3%,Ｐ＜0.001). Though the elderly group did not differ significantly in the occurrence of severe heart events from that of the latter, the rate of revascularization in the former was higher than that in the non elderly group during 6.54 months of follow up.