年龄对冠心病患者植入生物涂层可降解支架预后的影响

目的 探讨老年(≥65岁)冠心病患者植入生物涂层可降解支架(BP-SES)术后1年净不良临床事件(NACCE)的发生情况.方法 回顾性分析I-LOVE-IT 2研究中植入生物涂层可降解支架的患者资料.入选2012年10月-2013年6月沈阳军区总医院住院期间在冠心病手术中行生物涂层可降解支架植入治疗的老年患者1829例,其中老年组(年龄≥65岁)627例,非老年组(年龄<65岁)1202例.主要观察终点为12个月的靶病变失败率(TLF),次级终点为NACCE发生率,包括全因死亡、心肌梗死、卒中和严重出血(BARC≥3型),并对其进行多因素回归分析.结果 两组在BMI、糖尿病、高血压、高脂血症、冠心病家族史、吸烟史、既往卒中病史、外周血管病病史、稳定型心绞痛等方面的基线情况差异有统计学意义(P<0.05).老年组与非老年组在NACCE发生率(10.0%vs.5.2%,P<0.01)、全因死亡(2.7%vs.0.7%,P<0.01)、心肌梗死(5.6%vs.3.5%,P=0.03)、支架内血栓(1.9%vs.0.5%,P<0.01)、卒中(2.2%vs.0.8%,P=0.01)差异有统计学意义.多因素回归分析结果 显示为NACCE(OR=1.904,95%CI 1.304~2.781,P=0.001)的独立预测因素.结论 老年冠心病(≥65岁)植入生物涂层可降解支架患者,术后1年NACCE发生率明显增加,且老年为其独立的预测因素.

Impact of age on the prognosis of patients with coronary heart disease implanted with biodegradable coating stents

Objective To evaluate the incidence of net adverse clinical and cerebral events (NACCE) 1 year after implantation of biodegradable polymer stents (BP-SES) in elderly patients with coronary artery disease.Methods The clinical data of patients inserted with BP-SES in I-LOVE-IT 2 Trial were retrospectively analyzed, including 1829 elderly patients admitted in the General Hospital of Shenyang Military Command from Oct. 2012 to Jun. 2013, of which 62 cases aged equal to and more than 65 years (elderly group) and 1202 cases less than 65 years (non-elderly group). The primary end-point of this research was target lesion failure (TLF) rate on 12 months and the secondary end-point was the incidence of NACCE, including all-cause death, all myocardial infarction, stroke and severe hemorrhage (BARC type ≥3), and then the multiple regression analysis was performed.Results The Baseline conditions of the two groups were significantly different (P<0.05) including BMI, diabetes, hypertension, hyperlipidemia, family history of coronary heart disease, smoking history, past stroke history, history of peripheral vascular disease and stable angina pectoris. When comparing elderly group with non-elderly group, marked differences existed on the incidence of NACCE (10.0%vs. 5.2%,P<0.01), all-cause mortality (2.7%vs. 0.7%,P<0.01), myocardial infarction (5.6%vs. 3.5%,P=0.03), stent thrombosis (1.9%vs. 0.5%,P<0.01) and stroke (2.2%vs. 0.8%,P=0.01). Multiple regression analysis revealed that elderly (age ≥65) was the independent predictive factor for NACCE (OR=1.904, 95%CI 1.304-2.781,P=0.001).ConclusionThe incidence of NACCE is increased significantly in elderly patients (age ≥65), and elderly is an independent predictive factors for 12-month NACCE in patients implanted with BP-SES