老年急性心肌梗死患者直接冠状动脉介入治疗的特点及疗效

目的分析老年急性心肌梗死（AMI）患者行直接冠状动脉介入治疗（PCI）的可行性及近远期疗效。方法196例AMI患者分为老年组（108例）和非老年组（88例），分析两组患者临床特征、冠脉病变特点、是否进行球囊预扩张、支架植入情况、近远期疗效。结果老年组患者多有冠心病史（44．4％vs23．9％，P=0．003）；老年组梗死相关动脉（IRA）以LAD（50．9％）和RCA（44．4％）为主，非老年组IRA以LAD（59．1％）为主（P=0．005）；两组IRA狭窄程度、病变形态无差异性（P均〉0．05）；老年组常有2支或3支冠脉病变（80．6％），非老年组患者以单支病变为主（46．6％，P=0．001）；与非老年组相比，老年组支架植入前常需进行球囊预扩张（89．2％vs72．3％，P=0．004），但植入支架直径、长度及血运重建程度无差异性。住院及随访期间老年组靶血管血运重建率及死亡率均较非老年组偏高，但未达到统计学意义。结论老年AMI患者进行直接PCI安全有效，但与非老年患者相比，支架植入前常需进行球囊预扩张。

Clinical characteristics of primary percutaneous coronary intervention in elderly patients with acute myocardial infarction and its therapeutic effect

Objective To investigate the feasibility of primary percutaneous coronary intervention(PCI) in the elderly patients with acute myocardial infarction(AMI) and its long-term therapeutic effect.Methods 196 patients with AMI consecutively treated by primary PCI were divided into elderly group(108 cases) and non-elderly group(88 cases),the baseline clinical characteristics,coronary angiogram,PCI procedure and major cardiac events were analyzed.Results The main infarct related arteries were LAD(50.9%) and RCA(44.1%) in elderly group,the IRA in non-elderly group were LAD(59.1%).There was significant difference in number of diseased vessels between two groups.89.2% patients in elderly group need balloon predilatation before stent transplantation.There were no significant differences in form and stenosis,stent length,diameter and the extent of revascularization,and incidence of major cardiac event in short-term and longterm between the two groups.Conclusions The primary PCI is a safe and effective measure for the elderly patients with AMI.However,balloon predilatation before stent transplantation is often necessary.