85岁及以上老年冠心病患者经皮冠状动脉支架治疗的临床观察

目的 探讨85～94岁冠心病患者经皮冠状动脉支架治疗的疗效和预后.方法 回顾性分析90例85岁以上冠心病患者经皮冠状动脉支架治疗的临床和造影特点、住院期间和长期疗效.结果 90例中,21例应用金属裸支架(BMS),69例应用药物洗脱支架(DES).三支病变41例,2支病变21例,单支病变28例.手术成功率为94.4%,术前与术后TIMI-3级血流比例分别为72.2%和94.4%.手术相关并发症为15.6%,主要为冠脉夹层(11.1%).住院期间主要心血管不良事件(MACE)为7.8%,其中DES组住院期间MACE为5.8%,BMS组为14.3%.DES组出现2例严重出血.86例患者随访1年时,总的MACE为4.6%,其中DES组为6.0%,BMS组没有任何MACE.DES组出现]例脑卒中和1例严重出血.47例患者随访2年时,总的MACE为14.9%,其中DES组MACE为19.4%,BMS组无任何MACE.DES组1例发生严重出血,BMS组1例发生脑卒中.多因素COX回归分析表明,肌酐水平和高血压是影响长期预后的重要因素.结论 85岁以上冠心病患者经皮冠状动脉支架治疗手术成功牢较高,住院期间和长期的MACE事件发生率较低,并存高血压和严重.肾功能不全的患者MACE的发生率相对较高.

In-hospital and long term clinical outcomes of patients aged 85 years and over with coronary heart disease undergoing stent-based percutaneous coronary intervention

Objective To evaluate the in-hospital and long term clinical outcomes of patients aged 85 years and over with coronary heart disease undergoing stent-based percutaneous coronary intervention(PCI). Methods A total of 90 patients aged 85 years and over with coronary heart disease(CAD)undergoing the stenting were enrolled in this study.The data of baseline characteristics.procedural details,in-hospital and 1 year clinical follow-up outcome including major adverse cardiac event(MACE),stroke and other major bleeding were collected and analyzed. Results Of the 90 patients,21(23.3%)underwent bare metal stent(BMS)implantation;69(76.7%),drug eluting stent(DES)implantation;A total of 41(45.5%)had 3 vessel diseases,21(23.3%)had double vessel diseases and 28(3 1.1%)had single vessel disease.The procedure success rate was 94.4%with TIMI-3 coronary flow of post-PCI in 94.4% vessels while TIMI-3 coronary flow of pre-PCI only in 72.2%vessels.Procedure-related complications occurred in 15.6%of the patients with 11.1% incidence of dissection.In-hospital MACE was 7.8%.Two cardiac deaths and 2 myocardial infarctions(MI)occurred accounting for the in-hospital MACE of 5.8% in DES group,while therewere 2 cardiac deathsind 1 M1 accounting for the in-hospital MACE of 14.3% in BMS group.Two major bleeding occun ed in DES group.One year clinical follow-up incidence of MACE was 4.6%(4/86),in DES group was 6.0%,while there was no MACE in BMS group.One stroke and 1 major bleeding occurred in DES group.Two years clinical follow-up incidence of MACE was 14.9%(7/47),in DES group was 1 9.4%while there was no MACE in BMS group.One major bleeding occurred in DES group and 1 stroke occurred in BMS group.Multiple factors COX regression analysis showed that the creatinine level[OR:1.02(1.01-1.03),P=0.004]and hypertension[OR:3.20(1.00-10.22),P=0.043 were major factors affecting the long-term MACE. Conclusions Percutaneous coronary stenting in CAD patients aged 85 years and over has high procedure success rate and low in-hospital mortality and low MACE during long-term follow up.The very elderly patients who have severe renal disease and hypertension may have relatively high incidence of MACE.