介入治疗对高龄急性心肌梗死患者临床预后的影响

目的　观察直接经皮冠状动脉内介入 (PCI)对高龄ST段抬高的急性心肌梗死 (STEMI)患者临床预后的影响。方法　STEMI连续行直接PCI的患者 1 56例 ,对IRA行直接PCI。随访 1～ 1 2个月患者主要心血管事件 (MACE)的发生率。结果　≥ 75岁组较 <75岁组中脑卒中比例较高 (P <0 0 5) ,患者发病至再灌注时间延长 (P <0 0 5) ,左室射血分数 (LVEF)降低 (P <0 0 5)。共随访 1 4 5例患者 ,两组住院期发生非致命性再次心肌梗死差异无显著性 ,但≥ 75岁组心脏性死亡增高 (9 4%比1 8% ,P <0 0 5) ;随访平均 (7 3± 3 2 )个月 ,≥ 75岁组患者总心脏性病死率明显高于 <75岁组(1 2 5 %比 1 8% ,P <0 0 5)。多变量logistic回归分析提示年龄≥ 75岁与LVEF值降低分别与STEMI患者行直接PCI后心脏性死亡增加密切相关 ,是心脏性死亡事件危险增高的独立预测变量。结论　年龄≥ 75岁因素可能是STEMI患者行直接PCI后心脏性死亡增加的独立预测因子

The effect of age on the clinical outcomes of patients with acute myocardial infarction treated by direct percutaneous coronary intervention

OBJECTIVE: To investigate the effect of old age on the clinical outcomes of patients with ST-segment elevation acute myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). METHODS: 156 consecutive patients with STEMI treated by primary PCI were divided into two groups according to the age of patients: (1) >or= 75 years group (35 cases), with a mean (79.6 +/- 4.1) years; (2) < 75 years group (121 cases), with a mean (60.5 +/- 8.7) years. The baseline clinical characteristics and coronary artery lesions were analyzed and major cardiovascular events (MACE) were followed-up during a period of 1 - 12 months. RESULTS: There were higher proportion of stroke, longer duration of onset of symptom to balloon and lower left ventricular ejection fraction (LVEF) in patients >or= 75 years than in those < 75 years (all P < 0.05). Coronary angiogram indicated there was lower percentage of patients with single vessel disease, but higher percentage of patients with multivessel disease in >or= 75 years group than in < 75 years group (all P < 0.05). One hundred and forty five patients (32 cases >or= 75 years and 113 cases < 75 years) were followed-up. No significant difference in rate of non-fatal reinfarction was found between the 2 groups, but the hospital cardiac mortality was higher in patients >or= 75 years than in those < 75 years (9.4% vs 1.8%, P < 0.05). During a mean of (7.3 +/- 3.2) months follow-up, the total cardiac mortality rate increased significantly in >or= 75 years group than in < 75 years group (12.5% vs 1.8%, P < 0.05). Multivariate logistic regression analysis showed that age >or= 75 years and decrease in LVEF were associated with increased cardiac mortality in patients with STEMI referred to primary PCI. CONCLUSION: Age >or= 75 years was an independent predictor for increase in cardiac mortality in patients with STEMI treated by primary PCI.