老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年(≥80岁)急性心肌梗死(AMI)患者行急诊与择期经皮冠状动脉介入治疗术(PCI)的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组(AMI组)和非心肌梗死组(对照组),其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者(AMI择期组)和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率(72.2%)低于非急诊组(92.2%),差异有统计学意义(P=0.036)。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义(P<0.001,P=0.039),AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高(P<0.05)。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。

The efficiency and recent safety of percutaneous coronary intervention in the very elderly patients with acute myocardial infarction

Objective We aimed to evaluate the efficiency and recent safety of primary and elective percutaneous coronary intervention (PCI) in the very elderly patients(≥ 80 years old) with acute myocardial infarction(AMI). Methods 120 very elderly patients with coronary heart disease (CHD) were enrolled and divided into AMI group and non-AMI group (control group). The AMI patients (with an onset of the disease within 12 hours) underwent primary PCI (P-PCI) at admission, while the others in AMI group and the non-AMI patients received elective PCI. The baseline clinical characteristics, angiographic features and in-hospital outcomes of patients in all groups were compared retrospectively. Results The procedure success rate (PSR) with TIMI-3 flow grade of post-PCI was lower in P-PCI group (72.2% VS 92.2%,P=0.036).P-PCI significantly increased the occurrence of the procedure-related complications in whole-group and AMI-group patients (55.6% VS 14.7% P<0.001; 55.6% VS 27.0% P=0.039; respectively). The occurrence of the procedure-related complications and major adverse cardiac event rates (MACE) and in-hospital mortality were significantly increased in AMI group. Conclusions Although P-PCI had a higher risk of complications compared with elective procedure, the success rates in both of them were still high and the difference was not significant as to in hospital mortality rate and incidence of MACE in both primary and elective settings in very elderly AMI patients.