目的观察年龄>65岁老年患者经皮冠状动脉介入(PCI)的远期疗效。方法将2003年1月至2005年1月在上海交通大学医学院附属瑞金医院心脏科行PCI治疗并完成随访的1012例患者根据年龄分为>65岁组(583例)和≤65岁组(429例),记录各组患者的一般资料、临床特征和冠状动脉造影及PCI情况。术后每3个月通过随访记录患者所有原因病死、中风和主要心脏不良事件。比较>65岁组患者药物洗脱支架和普通金属支架的临床疗效。结果与年龄≤65岁组比较,年龄>65岁组患者女性较多、体重较轻、吸烟史少,但高血压病及慢性肾功能不全多见,而且冠状动脉病变程度严重、PCI同期行肾动脉支架术患者增多、完全血运重建率和药物洗脱支架置入比例较低。平均随访17个月,年龄>65岁组与年龄≤65岁组比较,主要心脏不良事件(12.52%对8.62%,P<0.05)、所有原因病死率(5.83%对1.17%,P<0.01)和所有不良事件(15.27%对9.09%,P<0.01)发生率均增高。年龄>65岁组患者中,药物洗脱支架组较普通金属支架组主要心脏不良事件发生率显著减少(10.14%对16.51%,P<0.05),但心源性病死率(3.01%对4.59%,P>0.05)和所有原因病死率(5.48%对6.42%,P>0.05)差异无显著性意义。结论年龄>65岁老年患者冠状动脉支架术后远期心脏事件和所有原因病死率显著增加;药物洗脱支架可明显降低主要心脏不良事件发生率,但不能减少心源性和非心源性死亡。 Objective To observe the long-term efficacy of percutaneous coronary intervention (PCI) in elderly patients> 65 years of age. Methods From January 2003 to January 2005, 1012 patients who underwent PCI in the Department of Cardiology of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and from January 2005 to January 2005 were divided into two groups according to their age:> 65 years old (583 cases) and ≤65 years old 429 cases). The general information, clinical features, coronary angiography and PCI of each group were recorded. Follow-up was recorded every 3 months after surgery for all causes of death, stroke and major adverse cardiac events. Clinical efficacy of drug-eluting stents and metal stents in patients> 65 years old. Results Compared with age ≤65 years old, the patients of age> 65 years old had more females, lighter weight, less smoking history, but hypertension and chronic renal insufficiency were common, and the degree of coronary artery disease was serious. Artery stenting patients increased, complete revascularization rate and drug-eluting stents into a lower proportion. The patients were followed up for an average of 17 months. The major adverse cardiac events (12.52% vs. 8.62%, P <0.05) were higher in all age groups> 65 years and younger than 65 years (P> 0.05) And all adverse events (15.27% versus 9.09%, P <0.01). The incidence of major cardiac adverse events in drug-eluting stent group was significantly lower than that in common metal stent group (10.14% vs 16.51%, P <0.05) at age> 65 years. However, the CFR of 3.01% versus 4.59% , P> 0.05) and all causes of mortality (5.48% vs. 6.42%, P> 0.05). CONCLUSIONS: Long-term cardiac events and all-cause mortality were significantly increased in elderly patients aged> 65 years after coronary stenting; drug-eluting stents significantly reduced the incidence of major cardiac adverse events but did not reduce cardiogenic and non-cardiac death .