老年急性非ST段抬高型心肌梗死GRACE评分高危与低危患者经皮冠状动脉介入治疗近期与远期疗效

目的：探讨老年（≥60岁）急性非ST段抬高型心肌梗死（NSTEMI）患者早期经皮冠状动脉介入治疗（PCI）的必要性及安全性。方法收集2011年1月至2012年12月期间在沈阳军区总医院心血管内科住院诊断为NSTEMI并且接受PCI治疗的439例老年（≥60岁）患者。依据入院时的临床检查及化验指标，对每名患者进行全球急性冠状动脉事件注册（GRACE）评分，以评分结果进行分组（低危组评分≤140、高危组评分＞140），比较两组的冠状动脉病变特点、PCI的术后并发症发生率、住院期间及术后1年内主要不良心脏事件（MACE）和终点事件的发生率。结果两组患者共入选439例，其中男性273例，女性166例，男性平均年龄68.4岁，女性平均年龄70.3岁。比较两组冠状动脉病变特点，高危组更多合并双支或三支血管病变（P＜0.05），差异有统计学意义（P＜0.05）。比较两组总的终点事件发生率，全因死亡终点事件发生率和住院期间死亡终点事件发生率，差异均无统计学意义（P＞0.05）。亚组分析：两组年龄≥80岁患者之间以及高危组中年龄≥80岁与＜79岁两者之间总的终点事件发生率的比较，差异无统计学意义（P＞0.05）。高危组≥80岁与＜79岁两者之间的死亡（包括非心源性及心源性）终点事件发生率比较，差异无统计学意义（P＞0.05）。结论 GRACE评分是一种应用广泛、快速的心血管疾病评价方法，可以对临床预测并指导患者的早期干预，尤其对于老年NSTEMI患者进行早期干预治疗具有指导意义，并对其冠状动脉血管病变程度及复杂性有一定预测价值。

Short- and long-term efficiency of percutaneous coronary intervention for elderly non-ST-segment elevation myocardial infarction patients with different GRACE risk score

Objective To determine the necessity and safety of early percutaneous coronary intervention （PCI） in treatment of≥60-year-old elderly patients with acute non-ST-segment elevation myocardial infarction （NSTEMI）. Methods A total of 439 elderly patients （age ≥60 years） diagnosed as NSTEMI and undergoing PCI treatment in our department from January 2011 to December 2012 were subjected in this study. According to the results of clinical biochemical examinations, every patient was registered for global acute coronary event registration, named Global Registry of Acute Coronary Events （GRACE）. Based on their GRACE scores, these patients were stratified into low-and high-risk groups （low risk ≤140, high-risk 〉140 scores）. The major adverse cardiac events （MACE） were documented during hospitalization and 1 year of follow-up. The characteristics of coronary artery lesions, the incidence of complication after surgery, and the incidence of MACE and end events were compared between the 2 groups. Results Among the subjected 439 patients, there were 273 males and 166 females, with a mean age of 68.4 years for the former and 70.3 years for the later. There were obviously more multi-vessel lesions in high-risk group than in low-risk one （P〈0.05）. There was no significant difference in the incidences of total end events, all-cause mortality events, and in-hospital mortality end events between the 2 groups （all P〉0.05）. There was either no difference in the incidence of total end events between those ≥ 80 years old patients from low-and high-risk groups, and between those ≥80 and 〈79-year-old patients from the high-risk groups （both P〉0.05）. The mortality end events （non-cardiovascular and cardiovascular ） had no difference between those ≥80 and 〈79-year-old patients from the high-risk groups （both P〉0.05）. Conclusion GRACE scores are a rapid and widely-used system to assess cardiovascular diseases, and are beneficial for clinical prediction and guiding early inte