急诊经皮冠状动脉介入治疗老年急性心肌梗死合并心源性休克的临床观察

目的探讨急诊PCI对老年急性心肌梗死(AMI)合并心源性休克(CS)的近期和中期疗效,并分析患者院内存活率的影响因素。方法选择行PCI的老年AMI合并CS患者共86例,按治疗结果分为院内病死组(病死组,32例)和院内存活组(存活组,54例),采用logistic回归分析死亡的预测因素,统计患者的临床特点、影像学特点、介入治疗成功率、院内病死率及存活时间。结果病死组既往有心肌梗死患者高于存活组(43.8%vs24.1%,P=0.049),存活组发病至PCI时间明显低于病死组(9.8±3.2)hvs(12.7±5.9)h,P=0.004];病死组梗死发生部位为前降支,发生率明显高于存活组(59.4%vs35.2%,P=0.025);Kaplan-Meier生存分析显示1年生存率为51.2%。logistic多元回归分析显示,发病至PCI时间及梗死相关动脉与院内病死率显著相关(P<0.05)。结论急诊PCI对老年AMI合并CS患者有较好的近期和中期疗效。

Emergency PCI in treatment of elderly patients with acute myocardial infarction complicated by cardiogenic shock

Objective To elucidate the short-and mid-term efficacy of emergency percutaneous coronary intervention(PCI)in treatment of elderly patients with acute myocardial infarction(AMI)complicated by cardiogenic shock(CS),and to investigate the factors influencing the in-hospital mortality.Methods All the patients diagnosed as AMI complicated by CS and treated with urgent PCI at Shenyang Northern Hospital between 2001 and 2006 were enrolled in the study.The clinical and angiographic characteristics and the short-and mid-term outcome were analyzed.Results Eighty-six patients with an average age of(71.7±6.3)years were included and 44.2% of them were females.The in-hospital mortality rate was 37.2%,and Kaplan-Meier survival analysis showed that one-year survival rate was 51.2%.Binary logistic regression analysis demonstrated that the time from onset of AMI to PCI and LAD infarction correlated with in-hospital mortality(OR=1.19 and 3.42,P<0.05).Conclusion The data confirm that emergent PCI therapy for elderly patients with AMI complicated by CS is effective and the short-and mid-term outcome is satisfactory.