年龄对接受急诊冠状动脉介入术治疗急性ST段抬高心肌梗死患者预后的影响

目的评价年龄对接受急诊冠状动脉介入治疗(PCI)老年急性ST段抬高心肌梗死患者临床预后的影响。方法 221例接受了急诊直接PCI治疗急性ST段抬高心肌梗死患者纳入本研究,根据年龄分为3组:65岁组(107例)、65～74岁组(74例)和≥75岁组(40例),收集基线资料包括年龄、性别、胸痛时间、心肌梗死部位、术前Killip分级、梗死相关血管、冠脉病变血管支数、支架类型、出院前左心室射血分数(LVEF)、心肌酶峰值、血红蛋白、血肌酐、血糖、冠心病危险因素(吸烟、肥胖、高血压、糖尿病和高血脂),临床随访平均(16.7±11.3)个月(6～38个月),主要不良心脏事件(MACE)发生36例。结果多因素Logistic回归分析显示,出院前LVEF是随访期总MACE发生的独立预测因素(P=0.0057)。在65～74岁组和≥75岁组中单支血管病变所占比例明显低于65岁组(P=0.0001);而在65～74岁组和≥75岁组中其双支病变、三支病变所占比例高于65岁组(P=0.0618,P=0.0340)。在65～74岁组和≥75岁组中Killip分级(Ⅱ、Ⅲ、Ⅳ级)的比例明显高于65岁组(P=0.0052);而在65～74岁组和≥75岁组中LVEF明显低于65岁组(P=0.0493);在65～74岁组和≥75岁组中高血压的比例明显高于65岁组(P=0.0162)。随着年龄增长,随访期间MACE发生率明显增高,在65岁组为10.28%、65～74岁组为16.22%、≥75岁组为32.50%(P=0.0051),差异有统计学意义。结论在接受急诊冠状动脉介入治疗的老年急性ST段抬高心肌梗死患者,MACE发生率随年龄增长而增高,年龄、多支血管病变、Killip分级和LVEF可能影响其预后。

Influence of age on clinical outcomes of primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction

Objective To evaluate the influence of age on clinical outcomes in elderly patients with acute ST- segment elevation myocardial infarction （STEMI） receiving primary percotaneous coronary intervention. Methods A total of 221 patients with acute STEMI receiving primary percutaneous coronary intervention between Jan. 2005 to Dec. 2007 were enrolled. A total of 221 patients with acute STEMI were divided into 3 groups according to age ：group 1 （ 〈65 years, n = 107）,group 2 （65-74 years, n = 74） and group 3 （≥ 75 years, n = 40）. Baseline parameters （age, gender, angiographic characteristics, Killip classification, chest pain time, LVEF, CK, CK-MB, cTnI levels, hemoglobin levels, and history of hypertension, diabetes,hyperlipidemia, obesity and smoking ） of 3 groups were collected. Clinical follow-up end point was major adverse cardiac event （MACE） including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was （ 16. 7 ± 11.3） months （from 6 to 38 months）. MACE occurred in 36 patients. Results Logistic regression analysis showed that LVEF was an independent predictor for MACE in the follow-up period （ P =0. 0057）. Rate of 1- vessel disease was significantly lower in group 2 and group 3 than in group 1 （P = 0. 0001 ）, however, rates of 2- vessel disease and 3-vessel disease were significantly higher in group 2 and group 3 than those in group 1 （ P = 0. 0618, P = 0. 0340 ）. Rates of Killio classification （ class Ⅱ ,Ⅲ,Ⅳ ） were siznificantlv lower in groun 2 and group 3 than in group 1 （ P = 0. 0052）. Average LVEF were significantly lower in group 2 and group 3 than in group 1 （ P = 0. 0493 ）. Rate of hypertension was significantly higher in group 2 and group 3 than in group 1 （ P = 0. 0162 ）. The incidence of MACE was increased with the increase of age （ 〈65：10. 28% ,65-74 ： 16. 22% , ≥75：32. 50% ,P =0. 0051 ）. Conclusions Age, muhivessel disease, Killip classification and LVEF may influence prognosis of elderly patients with acute STEMI receiving primary percutaneous coronary intervention.