摘要
目的探讨高龄急性冠状动脉综合征（ACS）患者行经皮冠状动脉介入（PCI）治疗四年的预后情况。方法依患者入院后治疗方法将观察病例分为2组，试验组48例，均以标准方法行PCI治疗，置入支架均为药物洗脱支架。对照组53例，给予药物保守治疗，未行PCI治疗。回顾性分析2组患者入院时的临床资料、4年的随访结果，比较2组患者的不同时期心血管事件发生率、全因病死率及影响预后的危险因素。结果2组患者临床资料无差异，试验组冠状动脉造影成功率为93．75％。造影结果提示单支病变6例，双支病变20例，三支病变22例，超过血管直径70％病变总数158处，A型病变12处，B1型病变36处、B2病变48处，C型病变62处。连续随访患者4年，2组失访率比较（8．33％与9．43％，χ2=0．04P=0．85）差异无统计学意义。试验组在出院至12个月区间心血管事件发生概率明显低于对照组（RR=2．89，χ2=3．83，P=0．05，RR95％CI=1．00，8．35），12—24个月区间心血管事件发生概率明显低于对照组（RR=3．18，χ2=4．47，P=0．03，RR95％CI为1．09，9．29）差异有统计学意义。36—48个月的随访中2组区间心血管事件发生概率差异无统计学意义。2组患者在随访期内生存率差异无统计学意义（χ2=2．22，P=0．14）。对2组患者入院时年龄、吸烟、原发性高血压、血肌酐（Cr）、总胆固醇（CHO）、甘油三酯（TG）血糖（Bs）、血尿酸（uA）、低密度脂蛋白胆固醇（LDL—C）等危险因素与心脏事件做Logistic回归分析，提示Bs、Cr、LDL—C、高血压病史、年龄〉80岁具有统计学意义（P均〈0．05）。结论高龄患者行PCI治疗降低了高龄患者住院期间及24个月内的心血管事件发生率，但并不降低远期心血管事件发生率，对患者长期生存率无影响。血Bs、Cr、LDL—C升高、高血压病史、年龄〉80岁是高龄患者发生心血管事件的危险因素。
Objective To evaluate the clinical outcomes of PCI in eider patient four years after the operationg Methods One hundred and one elder patients with ACS were divided into two groups according to the treatment during hospitalization： 48 patients in the.experimental group underwent primary PCI ;53 patients in control group underwent conservative treatment without PCI. For all the patients, the clinical data on admission and during the four-year follow-up were retrospectively analyzed and the incidence of cardiovascular events at different period, all-cause mortality and prognostic risk factors were compared. Results There was no statistical difference in baseline data between the two groups. The success rate of PCI in experimental group was 93.75% Imaging examination suggested that the numbers of single vessel lesion, double- vessel lesion and three-vessel lesion were observed in 6,20 and 22 of the patients, respectively; One hundred and fifty-eight cases had lesions involved more than 70% of the vascular diameter; The numbers of type A , B1, B2 and C vessel lesions were 12, 36,48,and 62,respectively. There was no significant difference（8. 33% vs 9.43% ,χ2 =0.04,P =0. 85） in the lost follow-up rates in the two groups in the four years＇ follow-up. The adverse cardiovascular events incidence in the experimental group were significantly lower than that in the control group during the first 12 months after operation（ RR = 2. 89, χ2 = 3.83 ,P = 0. 05 ,RR95% CI： 1.00,8. 35 ）. The adverse cardiac events incidence in the experimental group was significantly lower than in control group during the second 12 months after operation （ RR = 3.18, χ2 = 6. 55,P = 0. 01,RR95 % CI： 1.09 - 9. 29）. There was no significant difference in the incidence of adverse cardiac events between the two groups during the 36 - 48 months after the operation There was no significant difference in the survival rate between the two groups during the follow-up period （ χ2 = 2. 22, P = 0. 14）. The logistic regression analysis for the cardiac events and risk factors such as age, smoking, high blood pressure, Cr, CHO, TG, BS, UA, LDL-C and so on demonstrated that age ≥ 80 years, high blood Cr, BS, LDL-C and high blood pressure were risk factors for adverse cardiac events （ P 〈 0.05 ）. Conclusion The adverse cardiac events incidence was significantly lower in eider patients with ACS who Underwent PCI in the following 24 months after operation, but there was no significant difference in terms of the long-term survival rate and adverse cardiac events incidence between the two groups. Age ≥ 80 years and high blood Cr, BS, LDL-C, high blood pressure were risk factors for adverse cardiac events.
出处
《中国综合临床》
2011年第10期1024-1028,共5页
Clinical Medicine of China
关键词
高龄
急性冠状动脉综合征
经皮冠状动脉介入
心血管事件
生存率
危险
因素
Elder
Acute coronary syndrome
Primary percutaneous coronary intervention
Cardiovascular events
Survival rate
Risk factors
