【摘要】 目的评价急诊经皮冠状动脉介入治疗(PCI)对老年急性ST段抬高型心肌梗死(STEMI)的临床疗效。方法回顾性分析2003年1月~2006年1月间住院首诊为STEMI并且接受急诊PCI治疗的165例老年(≥70岁)患者的临床与6个月随访资料,并与同期的252例非老年患者(<70岁)比较。结果老年组女性(32.7%∶12.3%)、高血压(59.4%∶42.5%,)、糖尿病(23.0%∶10.3%),左主干病变(15.8%∶6.7%)和多支病变(78.8%∶56.0%)均多于非老年组(均P<0.01);非老年组有吸烟史者较老年组多(71.4%∶50.6%,P<0.01)。2组PCI成功率相当(98.2%∶97.2%,P>0.05),老年组患者住院病死率(4.8%∶1.2%,P<0.05)和不良心脏事件发生率(12.1%∶6.8%,P<0.01)较高。随访期间,老年组患者死亡(8.7%∶0.9%)、心力衰竭(20.0%∶5.6%)和总体主要不良心脏事件(42.0%∶26.9%,)的发生率均较非老年组高(均P<0.01)。结论与非老年患者相比,老年STEMI患者的临床与冠状动脉病变特征更高危,尽管急诊PCI的即刻成功率较高,但预后仍明显不如非老年患者。更多还原

【Abstract】 Objective:To evaluate the efficacy of primary percutaneous coronary intervention (PCI) on outcomes in elderly patients with acute ST elevation myocardial infarction (STEMI).Method:The one hundred and sixty-five elderly patients (≥70 years) with STEMI who underwent PCI were retrospectively analyzed and compared with two hundred and fifty-two non-elderly patients (<70 years) with STEMI and underwent PCI from January 2003 to January 2006 year.Result:The elderly STEMI group had more female (32.7% vs 12.3%, P<0.01), more hypertension (59.4% vs 42.5%, P<0.01), more diabetes mellitus (23.0% vs 10.3%, P<0.01) but fewer smokers(50.6% vs 71.4%,P<0.01) than those of the non-elderly STEMI group. Left main (15.8% vs 6.7%, P<0.01) and multi-vessel disease (78.8% vs 56.0%, P<0.01) were also more frequent in the elderly STEMI group. In-hospital mortality (4.8% vs 1.2%, P<0.05) and total MACE (12.1% vs 6.8%, P<0.01) were higher in the elderly STEMI group. But the procedural success rate of PCI (98.2% vs 97.2%, P>0.05) were the same between the two groups. During 6 months follow-up, all cause mortality (8.7% vs 0.9%, P<0.01), new-onset heart failure (20.0% vs 5.6%, P<0.01) and total MACE (42.0% vs 26.9%, P<0.01) in the elderly STEMI group were higher than those of the non-elderly STEMI group.Conclusion:Compared with the non-elderly patients, elderly patients with STEMI have poorer clinical and lesion profiles, worse in-hospital and follow-up outcomes despite a similar immediate success rate of PCI.更多还原