冠状动脉旁路移植术治疗老年无保护左主干冠状动脉病变的临床分析

目的 分析老年无保护左主干冠状动脉(冠脉)病变(ULMCA)患者行冠脉旁路移植术(CABG)的临床特点及预后.方法 选择经CABG治疗的ULMCA患者176例,根据年龄分为老年组(≥65岁,83例)和非老年组(＜65岁,93例).比较分析两组患者的临床特点、冠脉病变及远期临床预后.结果 老年组高密度脂蛋白胆固醇(mmol/L)明显高于非老年组(28.36±17.20比13.68±7.78,P＜0.01),低密度脂蛋白胆固醇(mmol/L)显著低于非老年组(1.21±0.77比2.48±1.27,P＜0.01).老年组左主干病变平均狭窄程度高于非老年组[(94.56±8.01)％比(87.96±11.10％),P＜0.01],合并多支病变(75.9％比58.1％,P＜0.05)及慢性完全闭塞病变(55.4％比29.0％,P＜0.05)多见.老年组和非老年组远期随访患者心脑血管事件(MACCE)、脑血管事件、心肌梗死、心源性死亡、总死亡事件发生率差异均无统计学意义(16.9％比17.2％,3.6％比3.2％,3.6％比5.4％,6.0％比9.7％,12.0％比8.6％,均P＞0.05).结论 老年ULMCA患者病情相对复杂,对于65岁以上者CABG可行,并且远期临床转归较为满意.

Coronary artery bypass grafting for elderly with unprotected left main coronary artery disease: a clinical analysis

Objective To study the correlation between the clinical features and the prognosis in elderly patients with unprotected left main coronary artery disease(ULMCA)after cornary artery bypass grafting(CABG).Methods The clinical parameters and prognosis data from 176 patients received CABG for ULM were retrospectively analyzed for comparison of elderly(age≥65)anagainst non-elderly(age＜65).Results The elderly patients were found to have significantly higher level of blood high density lipoprotein cholesterin(HDL-C,mmol/L:28.36± 17.20 vs.13.68± 7.78,P＜0.01),lower level of blood low density lipoprotein cholesterin(LDL-C,mmol/L:1.21 ± 0.77 vs.2.48 ± 1.27,P＜ 0.01)and higher level of coronary stenosis[(94.56 ± 8.01)％ vs.(87.96 ± 11.10)％,p ＜ 0.01].The incidence of multi-vessel disease(75.9％ vs.58.1％,P＜0.05)and chronic total occlusion(55.4％ vs.29.0％,P＜0.05)were both significantly higher in the elderly.No significant difference was found between the two groups in major adverse cardiac and cerebral events(MACCE),cerebral infarction,myocardial infarction,cardiac mortality,and total mortality(16.9％ vs 17.2％,3.6％ vs 3.2％,3.6％ vs 5.4％,6.0％ vs 9.7％,and 12.0％ vs 8.6％,all P＞0.05).Conclusion In the elderly ULMCA patients the coronary lesions are more severe,but CABG is still a safe and efficient therapy for these patients.