80岁以上高龄冠心病患者临床特点及预后分析

目的 总结分析高龄冠心病患者的临床特点,为其临床治疗决策提供参考.方法 选取2006年1月至2011年12月来北京安贞医院住院行冠状动脉介入治疗、≥80岁高龄冠心病患者315例(高龄组),并以同期住院的300例65岁以下冠心病患者作对照(对照组),对比分析2组患者的病史、临床、冠状动脉病变特点以及住院期间临床事件.结果 对照组与高龄组年龄分别为(52.4±17.6)岁和(81.6±2.1)岁.高龄组患者中,陈旧性心肌梗死、严重心律失常、血运重建史、心源性和非心源性合并症均明显多于对照组(均P＜0.01).高龄组左心室射血分数(LVEF)低于对照组[(46±13)％比(58±11)％,P＜0.01],空腹血糖、LDL-C、血清Cr水平均高于对照组[(7.9±2.1) mmol/L比(5.7±1.9) mmol/L,(4.2±1.7) mmol/L比(3.2±1.5) mmol/L,(141±57)μmol/L比(98±44) μmol/L,均P＜0.01].冠状动脉造影结果显示,高龄组多支、完全闭塞病变明显多于对照组,病变累及左主干者多于对照组(均P＜0.01).预后分析显示,高龄组出院后30 d和1年主要不良事件发生率均高于对照组[14.3％ (45/315)比3.7％ (11/300),30.2％ (95/315)比13.0％ (39/300),均P＜0.01].结论 高龄患者危险因素和各种心源性、非心源性合并症均多于低龄患者,且冠状动脉病变严重复杂,预后较差,因此决定治疗策略需全面分析.

Clinical characteristics and prognosis of elderly patients with coronary heart disease

Objective To analyze the characteristics and prognosis of elderly patients 80 years old or greater with coronary heart disease （CHD）. Methods A total of 315 elderly CHD patients admitted into hospital during recent 6 years were chosen and there were 300 CHD patients aged ≤ 65 years old who were chosen as control. The history, clinical data and coronary angiography were analyzed and compared. Results Among the elderly CHD patients, those risk factors including chronic myocardial infarction, serious arrhythmias, coronary revascularization history, cardiovascular or non-cardiovascular complications were all higher than those in control group （all P 〈 0. 01 ）. Echocardiography indicated that elderly patients had poor cardiac function [ left ventricular ejection fraction ： （46 ± 13 ） % vs （58 ~ 11 ） %, P 〈 0.01 ], and higher level of blood glucose, low density lipoprotein-cholesterol, and serium creatinine [ （7.9 ± 2.1 ） mmol/L vs （ 5.7 ± 1.9） mmol/L, （4.2 ± 1.7 ） mmol/L vs （3.2 ± 1.5 ） mmol/L, （ 141 ± 57）μmol/L vs（98 ± 44） μmo]/L, all P 〈0.01 ]. Coronary angiography demonstrated that multi-coronary arterial lesions, left main lesions and chronic total occlusion were more than those in control group （all P 〈 0.01 ）. Prognosis analysis indicated that all-cause mortality MACE in 30d and 1 year in elderly patients were all higher than that in control patients [ 14.3% （45/315） vs 3.7% （ 11/300 ）, 30.2% （95/315） vs 13.0% （ 39/300 ）, all P 〈 0. 01 ]. Conclusions The elderly CHD patients have more risk factors and complications than younger patients; their coronary lesions are serious and complex. Accordingly the prognosis is poor compared with those younger patients.