摘要
目的分析老年(≥65岁)冠心病患者接受血运重建后影响其预后的因素。方法6005例接受了血运重建,包括经皮冠脉介入治疗(PCI)和冠状动脉搭桥(CABG)的冠心病患者根据年龄分为两组,老年组(≥65岁,3728例)和对照组(<65岁,2277例),对患者进行电话或门诊随访,随访的中位数为555d,比较两组间临床情况和预后。结果两组间血运重建总死亡率和MACCE发生率差异有统计学意义,其中总死亡率(老年组与对照组)为3.5%与1.6%(P=0.001),MACCE为12%与3.9%(P=0.001)。与对照组相比,老年患者合并高血压、糖尿病以及脑血管病史、陈旧心梗史的发生率明显要高,而ST段抬高心梗、三支病变、左主干病变、CTO发生率也明显高,内生肌酐清除率、完全血运重建率却低。Cox多因素回归分析发现,糖尿病(HR2.011,95%CI1.093～3.697,P=0.027)、三支血管病变(HR2.036,95%CI1.123～3.813,P=0.017)、老年(≥65岁,HR5.605,95%CI2.001～15.705,P<0.001)是总死亡率增加的独立危险因素,而内生肌酐清除率(HR1.923,95%CI1.107～3.203,P=0.013)、左主干病变(HR1.877,95%CI1.193～2.978,P=0.001)、三支血管病变(HR1.515,95%CI1.243～1.806,P=0.007)是MACCE发生率增加的独立危险因素。结论糖尿病、三支血管病变、老年(≥65岁)是老年冠心病患者血运重建后总死亡率增加的独立危险因素,而内生肌酐清除率、左主干病变、三支血管病变是MACCE发生率增加的独立危险因素。
Objective To investigate the factors effecting the prognosis of coronary artery disease （CAD） in elderly patients （≥65 years old） receiving revascularization.Methods A total of 6005 patients with CAD were divided into two groups,including the elderly group （≥65 years old,n=3728） and the control group （〈65 years old,n=2277）.All of the patients accepted revascularization,including percutaneous coronary intervention （PCI） or coronary artery bypass graft （CABG）.The mean time of follow-up was 555 days.We intended to investigate the differences in total mortality and major adverse cardiac cerebral vessels events （MACCE） rate between the two groups,and also to analyze the factors affecting the prognosis of the elderly patients.Results There were obvious differences in total mortality （3.5% vs 1.6%,P=0.001） and MACCE rate （12% vs 3.9%,P=0.001） between the elderly group and the control group.The elderly also had a higher concomitant rates of diabetes mellitus （DM）,cerebrovascular disease,old myocardial infarction （OMI）,revascularization,diagnosis of ST-segment elevated myocardial infarction （STEMI）,multiple vessel lesions,left main disease,impaired creatinine clearance,and the rate of complete revascularization,etc.Multivariate Cox regression analysis showed that the risk factors affecting the total mortality of CAD in the elderly patients who had revascularization were concomitnce of DM （HR 2.011,95% CI 1.093-3.697,P=0.027）,triple vessel disease （HR 2.036,95% CI 1.123～3.813,P=0.017） and age （≥65 years old） （HR 5.605,95% CI 2.001～15.705,P0.001）.Factors affecting the MACCE rate included creatinine clearance （HR 1.923,95% CI 1.107-3.203,P=0.013）,presence of left main disease （HR 1.877,95% CI 1.193-2.978,P=0.001） and triple vessel disease （HR 1.515,95% CI 1.243-1.806,P=0.007）.Conclusion The risk factors affecting the total mortality of CAD in elderly patients receiving revascularization were history of DM,triple vessel disease and age （≥65 years old）.The influencing factors of MACCE rate included impaired creatinine clearance,left main disease and triple vessel disease.
出处
《中国介入心脏病学杂志》
2010年第2期80-83,共4页
Chinese Journal of Interventional Cardiology
关键词
老年
冠心病
血运重建
预后
Elderly
Coronary artery disease
Prognosis
Revascularization
