Minai Kazuo, Horie Hajime, Takahashi Masayuki, Nozawa Masato, Kinoshita Masahiko
First Department of Internal Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Japan.
Am Heart J. 2002 Mar;143(3):497-505. doi: 10.1067/mhj.2002.120778.
Although coronary reperfusion therapy with thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) immediately after acute myocardial infarction (AMI) has survival benefits for younger patients, the effect of coronary reperfusion therapy for very elderly (aged 80 years and older) patients with AMI remains controversial.
We studied 120 patients aged 80 years and older at relatively low risk with AMI. The patients were randomized into a primary PTCA group (n = 61) or a "conservative" no-PTCA group (n = 59). Long-term follow-up examination was conducted with regard to endpoints, which included all causes of death, cardiac death, nonfatal re-MI, the development of congestive heart failure, and cerebral vascular accident. End-diastolic volume index and end-systolic volume index were significantly increased in both groups at follow-up examination 6 months after AMI. However, left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index were similar between both groups. With endpoints of all causes of death, cardiac death, reinfarction, congestive heart failure, and cerebral vascular accident, a 3-year Kaplan-Meier event-free survival rate analysis revealed no significant benefits in the PTCA group. Anteroseptal MI, multivessel disease, and left ventricular ejection fraction were significantly associated with the combined events with multivariate Cox proportional hazards analysis results.
First, primary PTCA for very elderly patients with AMI appears to have few beneficial effects on combined events during a 3-year period. Second, early PTCA did not prevent left ventricle remodeling after AMI in patients with AMI at relatively low risk.
尽管急性心肌梗死(AMI)后立即使用溶栓药物或经皮冠状动脉腔内血管成形术(PTCA)进行冠状动脉再灌注治疗对年轻患者有生存益处,但冠状动脉再灌注治疗对高龄(80岁及以上)AMI患者的效果仍存在争议。
我们研究了120例80岁及以上、风险相对较低的AMI患者。这些患者被随机分为直接PTCA组(n = 61)或“保守”非PTCA组(n = 59)。对包括全因死亡、心源性死亡、非致死性再发心肌梗死、充血性心力衰竭的发生以及脑血管意外等终点进行了长期随访检查。在AMI后6个月的随访检查中,两组的舒张末期容积指数和收缩末期容积指数均显著增加。然而,两组之间的左心室射血分数、舒张末期容积指数和收缩末期容积指数相似。以全因死亡、心源性死亡、再梗死、充血性心力衰竭和脑血管意外为终点,3年的Kaplan-Meier无事件生存率分析显示PTCA组无显著益处。前间隔心肌梗死、多支血管病变和左心室射血分数与多变量Cox比例风险分析结果中的联合事件显著相关。
首先,对于高龄AMI患者,直接PTCA在3年期间对联合事件似乎几乎没有有益影响。其次,早期PTCA并不能预防相对低风险AMI患者AMI后左心室重构。