经皮冠脉介入治疗老年冠心病患者的预后及其影响因素

［摘要］目的: 分析老年(≥65岁)冠心病患者接受经皮冠脉介入治疗(PCI)术后影响其预后的因素。方法: 入选3 473例接受PCI术的冠心病患者，根据年龄分为老年组(≥65岁, n=2 005)和非老年组 (＜65岁, n=1 468)，对患者进行随访，随访时间中位数为577 d，比较并分析两组患者预后的差异及其影响因素。结果： PCI术后老年组总死亡率(3.6%)及主要心脑血管不良事件（MACCE）发生率(12.3%)均明显高于非老年组（分别为1.5%和3.3%，P均<0.001)。相较于非老年组，老年组患者高血压、糖尿病、脑血管病及陈旧性心肌梗死患病率和完全血运重建率明显增加。冠脉病变更严重，ST段抬高型心肌梗死、3支病变、左主干病变及慢性闭塞性病变发生率高，而内生肌酐清除率则明显低于非老年组。Cox多因素回归分析显示，糖尿病(HR=1.857，95% CI：1.121~3.142，P=0.012)，陈旧性心肌梗死史(HR=2.211，95% CI:1.113~4.112， P=0.015)，3支血管病变(HR=1.751，95% CI:1.135~2.653, P=0.006)及老年(HR=4.585，95% CI:2.013~9.201, P<0.001)是总死亡率增加的独立危险因素；而左主干病变(HR=1.976，95%CI:1.173~2.874，P<0.001) ，内生肌酐清除率(HR=1.975，95%CI:1.101~3.215，P<0.001 )及3支血管病变(HR=1.573，95%CI:1.263~1.886，P<0.001)是MACCE发生率增加的独立危险因素。 结论： 糖尿病、3支血管病变、老年是老年冠心病患者PCI全因死亡率增加的独立危险因素，而左主干病变、内生肌酐清除率、3支血管病变是MACCE发生率增加的独立危险因素。

Prognosis and potential modifying factors of coronary artery disease in theelderly with percutaneous coronary intervention

Objective: To investigate the factors affecting the prognosis of coronary artery disease(CAD) in the elderly group(≥65 years old) with percutaneous coronary intervention (PCI). Methods: A total of 3 473 patients with PCI were enrolled in this study. Patients were divided into two groups according to age,the elderly group(≥65 years old, n=2 005) and the control group(<65 years old, n=1 468). The mean time of follow-up was 577 days. We investigated the differences of the total mortality rate and major adverse cardiac cerebral vessels events(MACCE) between the two groups and analyze the factors which affect the prognosis of CAD. Results: The total mortality rate(3.6% vs 1.5%，P<0.001) and MACCE (12.3% vs 3.3%, P<0.001)were significantly higher in the elderly group than those of control group. Compared to the control group, the prevalence of hypertension，diabetes mellitus(DM), cerebrovascular disease, old myocardial infarction and complete revascularization rate in the elderly group were significantly higher.Coronary lesions were more serious,the incidence of ST segment elevated myocardial infarction(STEMI), triple vessel lesions, left main lesions and chronic total occlusion were higher in the eldly group,while endogenous creatinine clearance was significantly lower than the control group. Multivariate Cox regression analysis showed that the risk factors affecting the total mortality rate of CAD in the elderly with PCI were as follow: DM(HR:1.857, 95% CI:1.121-3.142, P=0.012) ,history of old myocardial infarction(HR2.211, 95% CI1.113-4.112, P=0.015), triple vessel injury(HR1.751, 95% CI1.135-2.653, P=0.006) and the elderly age (HR4.585, 95% CI2.013-9.201, P<0.001),those affecting the MACCE were creatinine clearance(HR1.975, 95% CI:1.101-3.215, P<0.001)，left main disease(HR1.976, 95% CI:1.173-2.874, P<0.001) , and triple vessel injury(HR:1.573, 95% CI:1.263-1.886, P<0.001). Conclusion: The risk factors affecting the total mortality of CAD in the elderly with PCI were DM and old myocardial infarction, triple vessel injury and the elderly age, those affecting the MACCE were left main disease, creatinine clearance and triple vessel injury. ［Key words］elderly; coronary artery disease; percutaneous coronary intervention; prognosis