高龄冠心病患者经皮冠状动脉成形术后并发症的危险因素分析

目的：了解行经皮冠状动脉成形术（ percutaneous coronary intervention ，PCI）的高龄患者的临床特征及手术的有效性和安全性，并探究与高龄患者行PCI术后并发症相关的危险因素。方法回顾性比较分析645例接受PCI手术的高龄（≥75岁，130例）和低龄（＜75岁，515例）冠心病患者的临床症状、入院时生化指标、PCI手术情况、PCI围术期和术后6个月主要并发症的发生率。结果与低龄冠心病PCI患者相比，高龄冠心病PCI患者平均体重较轻（ P＜0．01），血浆白蛋白、血红蛋白和血小板较低（P＜0．05），合并高血压、高脂血症、既往卒中史、急性心力衰竭、心律失常以及主干病变、双支和多支病变的比例较高（P均＜0．05），血浆B型尿钠肽（BNP）（P＜0．01）肌酐和尿素氮（P均＜0.05）较高，PCI术后不良事件发生率、造影剂肾病及与PCI相关的心肌梗死发生率（P均＜0．05）较高，术后住院时间较长（P均＜0．05）。单因素分析显示与≥75岁高龄患者PCI术后并发症相关的危险因素为：入院时合并心衰／严重心律失常、急诊PCI手术、多支病变、入院时肌钙蛋白升高等；多因素分析显示入院时合并急性心衰为≥75岁高龄患者PCI术后并发症相关的独立危险因素。结论虽然年龄不是PCI禁忌证，鉴于高龄患者常合并高血压、卒中、糖尿病、心、肾功能不全以及多支、复杂病变等危险因素，故在PCI手术之前，应完善对术后并发症相关危险因素的评估，慎重选择适应证、积极采取如水化治疗等预防措施，以降低PCI术后并发症发生率。

Analysis of risk factors for complications after percutaneous coronary intervention in elderly patients with coronary heart disease

Objective This research aimed to investigate clinical and angiographic characteristics of elderly patients who un -derwent percutaneous coronary intervention （PCI） and to evaluate the risk factors related to PCI complications in elderly patients .Meth-ods 645 subjects underwent PCI were divided into the elder group （age≥75 years old,130 subjects） and the younger group （age〈75 years old,515 subjects）.Clinical comorbidities,in-hospital biochemical indicators ,PCI-related data and perioperative and 6-month compli-cations were analyzed and compared between the two groups .Results Compared with the younger group ,elderly patients had lower aver-age weight （P〈0.01）,but higher BNP （P〈0.01） and serum creatinine （P〈0.05）.Hypertension,hyperlipoidemia,history of stroke, acute heart failure and severe arrhythmia were more commonly found in the elderly .Proportion of left main artery lesions and mutivessel lesions were also higher in the elderly group .Univariate analysis revealed that acute heart failure or severe arrhythmia at admission ,e-mergency PCI,mutivessel lesions,elevation of tropnin were related to perioperative and short-term （6 month） outcomes in elderly pa-tients underwent PCI .Logistic regression showed that acute heart failure at admission was the only independent risk factor predicting perioperative and short-term （6 month） outcomes in elderly patients underwent PCI .Conclusion Acommpanied with muti-cormobidi-ties such as hypertension,hyperlipoidemia,history of stroke,acute heart failure and severe arrhythmia and more complex coronary le-sions than younger patients ,elderly patients who receive PCI therapy should be cared more intensively with better evaluation of risk fac -tors,safety and effectiveness of PCI ,aiming to reduce PCI complications in such a special group patients .