急诊冠脉介入治疗高龄急性心肌梗死患者的临床特征和预后

摘要

目的 分析75岁以上高龄ST段抬高急性心肌梗死(STEMI)急诊经皮冠状动脉介入治疗( PCI)患者住院期间的临床特征和术后12个月的随访结果.方法 回顾性分析2005年3月至2010年3月,实行急诊PCI术的STEMI患者297例,年龄(59.33 ±11.42)岁,将高龄组(≥75岁)患者49例的临床特征、治疗结果和预后与对照组(＜ 75岁)患者进行对比.结果 高龄组患者占16.5％,年龄(77.46 ±2.37)岁,其中女性患者比例高于对照组(34.7％比19.8％,P＜0.05).高龄患者既往陈旧心梗、卒中较对照组多,分别是(18.3％比7.7％;30.6％比10.8％;P ＜0.05);其缺血时间较对照组长(4.66±2.49)h比(3.76±2.05)h,左室射血分数低(52.88±6.70)％比(55.66±7.51)％,P＜0.01;高龄组冠脉介入手术成功率、并发症发生率与对照组差异无统计学意义,分别是(93.9％比97.2％,4.1％比2.0％),P＞0.05;高龄组患者病变复杂,三支血管病变、术中再灌注心律失常发生率高于对照组,分别为(38.7％比23.5％;44.8％比28.6％,P＜0.05).住院期间和术后12个月两组患者在死亡、再梗死、卒中及靶血管重建率方面差异无统计学意义,术后12个月高龄组总体MACE高于对照组(22.4％比7.2％),P＜0.05.结论 尽管高龄组患者术后12个月的总体MACE高于对照组,但在手术成功率、并发症发生率、死亡、再梗死、卒中及靶血管重建率方面相似,急诊PCI是年龄≥75岁的高龄STEMI患者安全、有效的再灌注治疗策略.%Objective To analyze the clinical characteristics and prognosis of primary percutaneous coronary intervention (PCI) in patients ≥75 years old with ST-segment elevation acute myocardial infarction (STEMI) during hospitalization and after 12 months. Methods A retrospective analysis of 297 STEMI patients undergoing primary PCI admitted between March 2005 to March 2010 (mean age 59. 33 ± 11.42 years) was done. The clinical characteristics, treatment results and prognosis of the elderly group ( ≥75 years, n=49) were compared with the control group (n = 248). Results The elderly group accounted for 16. 5% of patients with mean age (77. 46 ±2. 37) years. The elderly group consisted more female patients than in the controls (34. 7% vs. 19. 8% , P < 0. 05). Elderly patients were more frequently to have old myocardial infarction and stroke (18. 3% vs. 7. 7% ;30. 6% vs. 10. 8% ;P <0. 05 .respectively) ; as well as long ischemic time (4.66 ± 2. 49) h vs. ( 3. 76 ± 2.05 ) h, and low LVEF (52. 88 ± 6. 70 ) % t?. ( 55. 66±7.51)%,P <0. 01. Coronary intervention success rate of the elderly group compared with the control was (93.9% vs. 97.2%, P>0. 05) and complication rate was (4.1% vs. 2. 0% , P > 0. 05 ). Complex lesions, multi-vessel disease, reperfusion arrhythmias of the elderly group was much higher than the control group (38.7% is. 23.5 %; 44.8% vs. 28.6%, P<0.05, respectively). The incidence of in-hospital death and death after 12 months, reinfarction, stroke, target vessel revascularization respectively were similar in both groups. Overall MACE increased in the elderly group after 12-month (22.4% vs. 7.2% ; P< 0. 05). Conclusions Although incidence of elderly group in overall MACE after 12 months was higher, the success rate of surgery, complication rate, death, reinfarction, stroke, target vessel revascularization respectively were similar in both group. Primary PCI is a safe and effective strategy for reperfusion therapy in elderly patients.