Cohen Howard A, Williams David O, Holmes David R, Selzer Faith, Kip Kevin E, Johnston Janet M, Holubkov Richard, Kelsey Sheryl F, Detre Katherine M
University of Pittsburgh Medical Center, Pittsburgh, Pa, USA.
Am Heart J. 2003 Sep;146(3):513-9. doi: 10.1016/S0002-8703(03)00259-X.
Older age has been associated with adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). As PCI technology evolves and the US population becomes proportionally older, assessment of PCI in older age groups is essential.
From the National Heart, Lung, and Blood Institute Dynamic Registry, 4620 PCI-treated patients (1997 to 1999) were studied. Differences in clinical presentation, treatment strategy, and inhospital and 1-year outcomes were compared between patient age groups: younger (<65 years, n = 2537); older (65 to 79 years, n = 1776); and elderly (> or =80 years, n = 307).
Older and elderly patients had more cardiac and comorbid noncardiac conditions and more extensive and complex arteriosclerosis, including stenoses in bypass grafts. Stent use was similar as age increased (72% vs 73% vs 73%), as was the use of IIb/IIIa receptor antagonists (29% vs 26% vs 28%). Rates of successful treatment of all attempted lesions were 93%, 92%, and 89%, respectively. Adjusted relative risks of inhospital death (1.0 vs 2.91 vs 3.64) and myocardial infarction (1.0 vs 1.35 vs 2.57) increased by age group, as did 1-year mortality rates (1.0 vs 1.87 vs 3.02). However, the relative magnitude of excess mortality rates at 1 year was comparable to that observed by age in the US general population. Age was not associated with 1-year risk of myocardial infarction or coronary artery bypass grafting.
Although new technologies may allow for treatment of complex disease in older and elderly patients with comorbid disease, the increased procedural risk remains substantial in these patients. After PCI, the long-term relative risk of death is similar to that expected among persons of similar ages in the general population.
高龄与接受经皮冠状动脉介入治疗（PCI）的患者不良预后相关。随着PCI技术的发展以及美国人口老龄化程度的增加，对老年人群PCI治疗情况的评估至关重要。
对美国国立心肺血液研究所动态注册研究中4620例接受PCI治疗的患者（1997年至1999年）进行研究。比较不同年龄组患者的临床表现、治疗策略、住院期间及1年预后：年轻组（<65岁，n = 2537）；老年组（65至79岁，n = 1776）；高龄组（≥80岁，n = 307）。
老年和高龄患者合并更多心脏及非心脏疾病，动脉硬化更广泛、更复杂，包括旁路移植血管狭窄。随着年龄增加，支架使用率相似（分别为72%、73%、73%），IIb/IIIa受体拮抗剂使用率也相似（分别为29%、26%、28%）。所有尝试病变的成功治疗率分别为93%、92%和89%。住院死亡（1.0 vs 2.91 vs 3.64）和心肌梗死（1.0 vs 1.35 vs 2.57）的校正相对风险随年龄组增加，1年死亡率也是如此（1.0 vs 1.87 vs 3.02）。然而，1年时额外死亡率的相对幅度与美国普通人群中按年龄观察到的情况相当。年龄与1年内心肌梗死或冠状动脉旁路移植术风险无关。
尽管新技术可能使合并疾病的老年和高龄患者能够治疗复杂疾病，但这些患者的手术风险增加仍然很大。PCI术后，长期相对死亡风险与普通人群中相似年龄者预期的风险相似。
