化繁为简策略在老年冠状动脉弥漫性长病变中的应用

摘要

目的 评价化繁为简策略在老年冠状动脉弥漫性长病变中的临床疗效.方法 连续选择75岁以上高龄240例冠状动脉弥漫性长病变且成功植入支架患者,根据全程还是局限支架置入,分为全程支架植入和点状支架植入两组,观察两组患者临床特征、病变特征、经皮冠状动脉介入治疗(PCI)情况和中远期预后.比较两组造影和手术成功率,随访用药情况,比较两组术后1年时主要心血管不良事件(MACE)及全因死亡率.结果 两组共随访235例,两组在心源性死亡[1.56%(2/128)比1.87%(2/107)]、非致死性心肌梗死[1.56%(2/128)比2.80%(3/107)]、全因死亡[4.69%(6/128)比4.67%(5/107)]、靶血管再次血运重建[2.34%(3/128)比5.61%(6/107)]、心绞痛复发方面[4.69%(6/128)比7.47%(8/107)]比较均差异无统计学意义(P>0.05).两组在冠状动脉造影随访方面[18.75%(24/128)比8.41%(9/107)]比较差异有统计学意义(P＜0.05).结论 老年冠状动脉弥漫性长病变可采用化繁为简策略行点状支架植入,远期临床疗效总体满意.%Objective To evaluate the clinical efficacy of the simplified strategy in the treatment of diffuse long lesions in the elderly. Methods Two hundred and forty patients over 75 years old with diffuse long coronary artery disease and successfully implanted stents were divided into two groups according to whether the stent placement was completed or limited. The clinical features, pathological features, percutaneous coronary intervention (PCI) status and long-term prognosis of the two groups were observed. The success rates of angiography and surgery were compared between the two groups. The medication was followed up. The major adverse cardiovascular events (MACE) and all-cause mortality were compared between the two groups at 1 year after surgery. Results There was no significant difference between the two groups in cardiac death [1.56% (2/128) vs. 1.87% (2/107)], non-lethal acute cardiac muscle infarction (AMI) [1.56% (2/128) vs. 2.80% (3/107)], all-cause death [4.69% (6/128) vs. 4.67%(5/107)], revascularization of target vessels [2.34%(3/128) vs. 5.61%(6/107)] and angina pectoris recurrence [4.69% (6/128) vs. 7.47% (8/107)], P > 0.05. The difference between the two groups was statistically significant only in the follow-up of coronary angiography [18.75%(24/128) vs. 8.41%(9/107)], P < 0.05. Conclusions The long diffuse coronary artery lesions in the elderly can be implanted with point stents by simplified strategy. The long-term clinical effect is generally satisfactory.