高龄急性冠状动脉综合征患者经皮冠状动脉介入治疗的临床观察

目的评价高龄急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)的效果和预后。方法收集入住本院的61例行PCI术的高龄ACS患者的临床资料,其中男性38例,女性23例,年龄为80~88(82±2)岁。19例行急诊PCI术,42例为择期PCI术,观察近期(住院期间)和远期主要不良心脑血管事件(MACCE)的发生和临床预后。结果61例患者中3支血管病变39例(64%),双支血管病变16例(26%),单支血管病变6例(10%);完全闭塞病变25例(41%);14例(34%)患者合并肾动脉狭窄。手术操作成功率97%,术后心肌梗死溶栓试验3级达97%,术后并发症发生率13%,其中造影剂肾病6例(10%)。住院期间MACCE发生率3%,均为心源性死亡,4个月至4年9个月随访期间MACCE发生率22%,包括3例心脑源性死亡、2例其他原因死亡。结论高龄ACS患者行PCI术手术操作成功率高,住院期间病死率和随访期间MACCE发生率较低,但患者病变重,并发症尤其是造影剂肾病发生率相对较高。

Clinical outcome in octogenarians with acute coronary syndrome after percutaneous coronary intervention

Objective To evaluate the efficacy and the clinical outcome of the percutaneous coronary intervention(PCI) in octogenarians with acute coronary syndrome(ACS).Methods A total of 61 octogenarians with ACS undergoing PCI were enrolled in this study. Thirty-eight were males and 23 were females,and the mean age of the patients was 82±2 years(80-88 years).Primary PCI was performed in 19 patients with Q-wave AMI and 42 patients underwent elective PCI.Results Of the 61 patients,39(64%) had three vessel diseases,16(26%) had double vessel diseases and only 6 had single vessel disease.The procedure success rate was 97% with TIMI-3 coronary flow in 97% vessels. Procedure-related complications occurred in 13% of the patients with the incidence of contrast-induced nephropathy being 10%.Two cardiogenic deaths occurred in hospital,accounting for the in-hospital MACCE of 3%.During the 4-57 months clinical follow-up,the incidence of MACCE was 22%.Conclusions PCI of octogenarians with ACS was effective with high procedure success rate and low in-hospital mortality and low MACCE during long-term follow up.But the octogenarian patients had severe coronary artery disease and relatively high incidence of complications especially contrast-induced nephropathy.