ten Berg J M, Bal E T, Gin T J, Ernst J M, Mast E G, Ascoop C A, Defauw J J, Plokker H W
Department of Cardiology, St. Antonius Hospital, Nieuwegein, Holland.
Cathet Cardiovasc Diagn. 1992 Jul;26(3):165-70. doi: 10.1002/ccd.1810260302.
In 212 patients aged 75 years and older the immediate and long-term results of percutaneous transluminal coronary angioplasty (PTCA) were assessed. For 293 stenoses the primary angiographic success rate was 96% and the overall clinical success rate was 90.6%. Angioplasty caused a myocardial infraction in 7 patients (3.3%), 2 patients (0.9%) needed emergency aorto coronary bypass surgery, and 4 patients (1.9%) died following the procedure. Actuarial 7 year survival was calculated at 69.3% with a standard deviation (SD) of 8%. Actuarial cardiac survival at 7 years was 92.1% (SD 3%), whereas non-cardiac survival at 7 years was 75.3% (SD 9%). Actuarially, at 7 years 98.5% (SD 1%) were estimated to remain free from myocardial infarction in the angioplasty-related area, 95.7% (SD 2%) to remain free from any myocardial infarction, 93.9% (SD 2%) to remain free from re-PTCA because of a recurrence, 84.7% (SD 5%) to remain free from any re-PTCA, and 97.1% (SD 2%) to remain free from (re)-operation. Fifty-two point three percent (SD 8%) were estimated to remain free from any cardiac event. If recurrence of angina is taken into account, only 25.8% (SD 13%) remain asymptomatic during 7 years follow-up. After successful angioplasty in patients aged 75 and older the chance of remaining free from any event or angina at 7 years actuarial follow-up gets as low as 15.7% (SD 9%). We conclude that in selected elderly patients angioplasty can be performed with a high success rate, although the periprocedural mortality and morbidity appear to be higher than in the younger age group. During long-term follow-up, most of the patients remain free of cardiac events and survival appears to be largely dependent on noncardiac factors. However, long-term relief from angina is probably less than in younger patients.
对212例75岁及以上的患者评估了经皮腔内冠状动脉成形术（PTCA）的近期和远期效果。针对293处狭窄病变，血管造影的初始成功率为96%，总体临床成功率为90.6%。血管成形术导致7例患者（3.3%）发生心肌梗死，2例患者（0.9%）需要紧急进行主动脉冠状动脉搭桥手术，4例患者（1.9%）术后死亡。经计算，7年精算生存率为69.3%，标准差（SD）为8%。7年精算心脏生存率为92.1%（SD 3%），而7年非心脏生存率为75.3%（SD 9%）。经精算，在7年时，估计98.5%（SD 1%）的患者在血管成形术相关区域无心肌梗死，95.7%（SD 2%）的患者无任何心肌梗死，93.9%（SD 2%）的患者因复发无需再次进行PTCA，84.7%（SD 5%）的患者无需进行任何再次PTCA，97.1%（SD 2%）的患者无需进行（再次）手术。估计52.3%（SD 8%）的患者无任何心脏事件。如果将心绞痛复发考虑在内，在7年随访期间只有25.8%（SD 13%）的患者无症状。在75岁及以上患者成功进行血管成形术后，7年精算随访时无任何事件或心绞痛的几率低至15.7%（SD 9%）。我们得出结论，在经过挑选的老年患者中可以进行成功率较高的血管成形术，尽管围手术期死亡率和发病率似乎高于年轻患者群体。在长期随访中，大多数患者无心脏事件，生存率似乎很大程度上取决于非心脏因素。然而，长期缓解心绞痛的情况可能比年轻患者少。
