90岁以上急性冠脉综合征支架治疗的长期观察

目的 探讨90岁以上急性冠脉综合征患者经皮冠状动脉支架治疗的疗效和预后.方法 回顾性分析17例90岁以上急性冠脉综合征患者(16.7%为ST段抬高心肌梗死,24.4%为非ST段抬高心肌梗死,47.8%为不稳定心绞痛)经皮冠状动脉支架治疗的临床和造影特点、住院期间和长期疗效.结果 在17例患者中,4例应用金属裸支架(bare metal stent,BMS),13例应用药物洗脱支架(drug eluting stent,DES).3支病变和2支病变各6例,单支病变5例.B2型和C型病变达88.2%.94.1%为不完全血运重建,82.3%植入1个支架,手术成功率为88.2%,术前与术后TIMI-3级血流比例分别为70.6%和88.2%.手术相关并发症为17.6%,均为冠脉夹层.住院期间主要心血管不良事件(major adverse cardiac event,MACE)为11.8%,其中1例心源性死亡(DES组)和1例心肌梗死(BMS组). DES组出现2例严重出血.生存的16例患者随访1年时无MACE、脑卒中和严重出血.生存的16例患者中12例随访18个月,总的MACE为8.3%,3例脑卒中,无严重出血.生存的16例患者中10例随访2年,总的MACE为20.0%,有3例脑卒中,无严重出血.结论 尽管采取不完全血运重建策略,90岁以上高危急性冠脉综合征患者可以从经皮冠状动脉支架治疗获益,住院期间和长期的MACE事件发生率较低.

Long-term outcomes in nonagenarians with acute coronary syndrome treated with percutaneous coronary stenting

Objective To evaluate the in-hospital and long term outcomes of patients aged 90 years and over with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) by using stenting. Method A total of 17 nonagenarians with ACS undergoing stenting were enrolled in this study. Three patients had ST segment elevation myocardial infarction (STEM) and 14 patients had non-STEMI of which 11 ones had unstable angina. The clinical characteristics before stenting, procedure details, in-hospital monitoring and follow-up for 12 months, 18 months and 24 months observed for major adverse cardiac event (MACE), stroke and other major complications were collected and analyzed. Results Of 17 patients, 4 (23.5%) were treated with bare metal stents (BMS) and 13 (76.5%) treated with drug eluting stents(DES). Six (35.3%) patients had three vessels involved, 6 (35.3%) patients had two vessels involved, and 5 (29.4%) had single vessel narrowed. The rate of complex coronary lesions (Type B2 + C) was 88.2% . The ratio of incomplete revascularization was 94.1%, and just one stent was implanted in 82.3% patients. The rate of successful implant was 88.2% with TIMI-3 coronary flow in 88.2% vessels after PCI, while the TIMI-3 coronary flow was only 70.6% vessels before PCI. Procedure-related complications occurred in 17.6% patients. The in-hospital MACE was 11.8% including 1 cardiac death (DES group) and 1 myocardial infarction (BMS group). Two cases of major bleeding occurred in DES group.There were no MACE, stroke and other major bleeding during one year follow-up. In a period of 18 months follow-up, the incidence of MACE was 8.3% (1/12) including 1 cardiac death. Two cases of transient ischemic attack (TLA) and one case of ischemic stroke occurred in DES group. In two years follow-up, the incidence of MACE was 20.0% (2/10). Two case of TIA and one case of ischemic stroke occurred in DES group. Conclusions The percutaneous stenting with either DES or BMS in nonagenarians with ACS was a highly successful procedure with low in-hospital mortality and low MACE during long-term follow-up despite incomplete revascularization.