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目的分析70岁上下冠心病(CAD)患者经皮冠状动脉介入治疗(PCI)的临床及预后。方法179例CAD患者分为A组(≥70岁,93例)和B组(<70岁,86例),择期行PCI;对比分析病史、左室舒张末内径(LVDD)和左室射血分数(LVEF),检测PCI前后血清肌酸激酶同工酶(CK-MB)和肌酐(SCr),观察冠状动脉造影(CAG)、PCI特点及术后主要不良心血管事件(MACE)发生情况。结果与B组比较,A组合并高血压、2型糖尿病、缺血性脑卒中及慢性阻塞性肺病率明显增高,LVDD增大、LVEF降低,术后24hCK-MB水平增高更显著,SCr水平术前及术后3d增幅均更显著,病变血管数和复杂、分叉、钙化、慢性完全闭塞性病变、植入支架数及术中并发症均明显增多,住院时间、住院期间及随访5～23个月,MACE发生率明显增高。COX回归分析表明,年龄每升高一个等级(25百分位数),MACE风险增加118.8%,LVEF每升高一个等级,MACE风险减少46.2%,合并糖尿病者远期MACE风险增加199.4%。结论高龄CHD患者合并多种慢性疾病,冠脉病变复杂,PCI并发症多,易致肾功能不全,预后较差。高龄、2型糖尿病、LVEF是CAD患者PCI后MACE的独立预测因子。
Objective To analyze the clinical and prognosis of percutaneous coronary intervention (PCI) in 70-year-old patients with coronary heart disease (CAD). Methods One hundred and seventy-nine patients with CAD were divided into two groups: group A (≥70 years old, 93 cases) and group B (≤70 years old, 86 cases) undergoing elective PCI. The history, left ventricular end diastolic diameter (LVDD) Serum creatine kinase (CK-MB) and serum creatinine (SCr) were measured before and after PCI. The incidences of coronary artery angiography (CAG), PCI and major adverse cardiovascular events (MACE) were observed. Results Compared with group B, the incidence of hypertension, type 2 diabetes mellitus, ischemic stroke and chronic obstructive pulmonary disease in group A were significantly increased, LVDD increased, LVEF decreased, and the level of CK-MB increased more significantly after operation Before and after the operation, the increase rate was even more significant. The number of vascular lesions and complex, bifurcation, calcification, chronic total occlusive disease, number of stent implantation and intraoperative complications were significantly increased. The length of hospital stay, hospitalization and follow-up Month, MACE incidence increased significantly. COX regression analysis showed that the risk of MACE increased by 118.8% for each level of increase (25th percentile), MACE risk decreased by 46.2% for each level of LVEF, and the long-term MACE risk for diabetic patients increased by 199.4%. Conclusion CHD patients with advanced chronic disease complicated by multiple coronary diseases, complicated with PCI complications, prone to cause renal insufficiency, the prognosis is poor. In advanced age, type 2 diabetes, LVEF is an independent predictor of MACE after CAD in patients with CAD.