摘要
目的分析发生冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变的老年冠心病患者的临床和影像学资料,并探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗对患者预后的影响。方法选取2013年2月至2015年11月在文山壮族苗族自治州人民医院接受治疗的346例CTO病变患者,根据年龄分为老年组(≥65周岁)149例和非老年组(<65周岁)197例,收集患者的临床特征、冠状动脉造影、手术情况等资料,并通过3年随访记录患者的心血管事件再复发和死亡情况。结果老年组术前血肌酐浓度、吸烟患者比例、三支血管病变患者比例、血管迂曲或钙化患者比例明显高于非老年组,差异有统计学意义(P<0.05);PCI治疗开通成功的老年和非老年患者再发心绞痛、急性心肌梗死、心力衰竭以及再次血运重建等心血管事件的总发生率(11.42%、9.62%)明显低于PCI治疗开通不成功患者(29.55%、26.83%),差异有统计学意义(P<0.05)。PCI治疗后的老年和非老年患者心血管事件发生率与病死率比较,差异无统计学意义(P>0.05)。合并左主干病变是老年冠状动脉CTO患者3年心血管死亡的危险因素(OR=3.196,95%CI:1.203~6.184,P<0.05)。结论 PCI治疗可作为老年冠状动脉CTO病变较为安全、有效的治疗方案。合并左主干病变是老年冠状动脉CTO患者3年心血管死亡的危险因素。
Objectives To analyze the clinical and imaging data of elderly patients with coronary heart disease with CTO,and to evaluate the effect of percutaneous coronary intervention(PCI)on the prognosis of the patients. Methods Totally 346 patients with CTO lesions who underwent treatment in People′s Hospital of Wenshan Prefecture from February 2013 to November 2015 were selected. They were divided into elderly group(≥ 65 years old)(n=149)and non elderly group(< 65 years old)(n=197)according to the age. The data of clinical features,coronary angiography and operation were collected,and the recurrence and mortality of cardiovascular events were recorded during 3 years of follow-up.Results Compared with non-elderly group,proportion of patients with smoking,preoperative serum concentration of creatinine,proportion of patients with three vessel lesions,vascular tortuosity or calcification in the elderly group were significantly higher(P<0.05);the overall incidence of cardiovascular events in the successful PCI opening elderly and non elderly patients with recurrent angina pectoris,acute myocardial infarction,heart failure and revascularization(11.42%,9.62%)were significantly lower than those of not successful PCI opening patients(29.55%,26.83%)(P< 0.05).Follow-up results showed no remarkable differences were noted in the incidence of cardiovascular events and deaths between the elderly and non elderly patients after PCI(P>0.05). Left main lesion was a risk factor for cardiovascular death in elderly patients with coronary CTO for 3 years(OR=3.196,95% CI:1.203-6.184,P<0.05). Conclusions PCI can be used as a safe and effective treatment for elderly patients with coronary CTO lesions. Pathological changes of left main lesion is a risk factor for cardiovascular death in elderly patients with coronary CTO for 3 years.
作者
张媛媛
王宇
李春霞
ZHANG Yuan-yuan;WANG Yu;LI Chun-xia(Department of Cardiovascular Medicine,People′s Hospital of Wenshan Prefecture,Wenshan,Yunnan 663000,China;Department of Cardiology,Longchang People′s Hospital,Longchang,Sichuan 642150,China)
出处
《岭南心血管病杂志》
2019年第6期613-617,共5页
South China Journal of Cardiovascular Diseases
关键词
冠状动脉疾病
慢性完全闭塞
经皮冠状动脉介入治疗
老年
预后
coronary artery disease
chronic total occlusion
percutaneous coronary intervention
elderly
prognosis
