摘要
目的观察>65岁慢性肾功能不全患者行冠状动脉内药物洗脱支架术的远期疗效。方法将585例年龄> 65岁行冠状动脉介入治疗(PCI)的患者,根据肌酐清除率分为慢性肾功能不全组(355例)和对照组(230例),前者又分药物脱支架组和普通金属支架组,记录各例患者住院期一般资料、冠状动脉造影和PCI情况及随访期所有原因死亡、中风和主要心脏不良事件。比较药物洗脱支架和普通金属支架对慢性肾功能不全组患者的临床疗效。结果与对照组比较,慢性肾功能不全组患者年龄增大,体重减轻,女性、吸烟和不稳定性心绞痛较多。平均随访17个月,慢性肾功能不全组较对照组所有原因病死率(8．17％和3．48％,P<0．05)和心源性病死率(6．48％和2．17％, P<0．05)显著增高,但主要心脏不良事件(13．80％和10．86％,P>0．05)及靶血管再次血运重建率(5．63％和6．08％,P>0．05)无显著差异。慢性肾功能不全组中,药物洗脱支架组(224例)较普通金属支架组(131例)主要心脏不良事件发生率(8．92％和19．84％,P<0．05)和靶血管再次血运重建率(3．12％和9．92％,P<0．05)显著减少,但心源性死亡(4．91％和8．39％,P>0．05)和所有原因死亡(6．25％和11．45％,P>0．05)发生率无显著性差异。结论年慢性肾功能不全患者行PCI术后死亡率增加;与普通金属支架比较,药物洗脱支架可以显著降低靶血管再次血运重建和主要心脏不良事件发生率,但对心源性死亡和所有原因死亡无明显影响。
Objectives To assess the long-term clinical outcomes in patients aged 〉 65 years with chronic renal insnfficiency after drug-eluting stent based percutaneous coronary intervention（PCI）. Method Clinical characteristics and long-term outcomes were compared between patients with renal insufficiency （Group Ⅰ; n = 355） and those with normal renal function （Group Ⅱ; n = 230） after percutaneous coronary drug-eluting stent implantation. Results During follow-up （average 17 months） after successful PCI, all-cause death （8.17% versus 3.48%, P 〈0.05） and cardiac death （6.48% versus 2.17%, P 〈 0.05）were significantly higher in group Ⅰ than in group Ⅱ. In patients with renal insufficiency, drug-eluting stent implantation reduced significandy the incidence of major cardiac adverse events （8.92% versus 19.84%, P 〈 0.05） and target vessel revascularization （3.12 versus 9.92%, P 〈 0.05）, but did not alter the rate of cardiac death （4.91% versus 8.39%, P 〉 0.05） and all-cause death （6.25% versus 11.45%, P 〉 0.05） compared with bare-metal stent implantation. Conclusion Renal insufficiency is an important factor influencing mortality after PCI in elderly patients with coronary artery disease. Drug-eluting stents should be the prefen-ed treatment for reducing the major cardiac adverse events in such patients.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2007年第3期152-155,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
血管成形术
经腔
经皮冠状动脉
支架
肾功能衰竭
预后
angioolasty, transluminal, percutaneous coronary
stents
kidney failure
prognosis
