Watanabe Ikuyoshi, Nagao Ken, Tani Shigemasa, Masuda Naoki, Yahata Takaharu, Ohguchi Sumito, Kanmatsuse Katsuo, Kushiro Toshio
Division of Cardiovascular Medicine, Surugadai Nihon University Hospital, 1-8-13 Kandasurugadai, Tokyo 101-0062, Japan.
Heart Vessels. 2006 Jul;21(4):236-41. doi: 10.1007/s00380-005-0897-6.
The increasing elderly population will influence the treatment policies adopted in cases of acute myocardial infarction. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we compared three strategies, as follows: primary percutaneous coronary intervention (primary PCI: n = 26), facilitated PCI with half the standard dose of mutant tissue-type plasminogen activator (t-PA) (half + PCI: n = 24), and facilitated PCI with a standard dose of mutant t-PA (standard + PCI: n = 15) between patients 75 and 80 years of age. The rate of acquisition of thrombolysis in myocardial infarction (TIMI-3) flow on initial coronary arteriography was significantly lower in the primary PCI group than in the other two groups (7.7% in the primary PCI group vs 60% in the half + PCI and 66.7% in the standard + PCI group). The incidence of hemorrhagic complications including blood transfusion was not significantly different between primary PCI and facilitated PCI. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we concluded that facilitated PCI may be effective in elderly patients aged 75-80 years.
老年人口的不断增加将影响急性心肌梗死病例所采用的治疗策略。在考虑老年急性心肌梗死患者的再灌注治疗时，我们比较了三种策略，具体如下：对75至80岁的患者进行直接经皮冠状动脉介入治疗（直接PCI：n = 26）、使用半量标准剂量突变型组织型纤溶酶原激活剂（t-PA）的易化PCI（半量+t-PA + PCI：n = 24）以及使用标准剂量突变型t-PA的易化PCI（标准剂量+t-PA + PCI：n = 15）。直接PCI组首次冠状动脉造影时心肌梗死溶栓（TIMI-3）血流获得率显著低于其他两组（直接PCI组为7.7%，半量+t-PA + PCI组为60%，标准剂量+t-PA + PCI组为66.7%）。直接PCI和易化PCI之间包括输血在内的出血并发症发生率无显著差异。在考虑老年急性心肌梗死患者的再灌注治疗时，我们得出结论，易化PCI可能对75至80岁的老年患者有效。
