直接PCI治疗高龄急性ST段抬高性心肌梗死

目的评价高龄急性ST段抬高性心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者行直接经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗的安全性和有效性。方法对比分析46例高龄STEMI患者（高龄组）和64例年轻STEMI患者（年轻组）冠状动脉造影特征、直接PCI治疗的情况．即刻手术成功率、住院及随访期间主要心血管事件的发生情况。结果高龄组与年轻组比较，冠状动脉病变多为多支病变（73．9％比28．1％，P〈0．01）；2组手术即刻成功率无明显差异；2组术后达到心肌梗塞溶栓（thrombolysis inmyoxardial infarction，TIMI）3级血流患者比率无明显差异；高龄组手术操作时间较年轻组长[（64．4±25．4）min比（49．7±21．8）min，P〈0．05]；高龄组住院期间、随访期间累计总的主要心血管事件发生率明显高于年轻组。随访期间，高龄组1例术后4个月猝死，死亡原因不明，1例术后1年死于脑出血：年轻组无死亡病例。结论对高龄STEMI患者行直接PCI治疗是比较安全而有效的再灌注手段。

Efficacy of primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction over 75 years old

Objectives To evaluate the safety and efficacy of primary percutaneous coronary intervention （PCI） in patients with ST-segment elevation myocardial infarction （STEMI） over 75 years old. Methods The data of patients who were underwent PCI within 12 h from beginning symptom onset during April 2005 to April 2008 were analyzed retrospectively. They were divided into the elderly acute myocardial infarction （AMI） group （ ≥ 75 years, n=46） and the younger group （ ≤60 years, n=64）. The immediate success rate and major adverse cardiac events （MACE） in two groups were analyzed during in-hospital duration and follow-up period. Results Compared with the younger group, the elder group were likely to have multi-vessels lesions. The time of procedure was longer in elder group than in the younger group. There was no significant on the immediate success rate and the rate of thrombolysis in myocardial infarction （TIMI） flow 3 between two groups. Compared with the younger group, the incidence of MACE were higher in elder group during in-hospital and follow-up period, too. There were 6 patients missed follow-up and 2 death in the elder group, while there were 5 patients missed follow-up and no death in the younger group during follow-up. Conclusions Primary PCI is also a relatively safe and effective reperfusion method in elder patients with STEMI.