Myler R K, Webb J G, Nguyen K P, Shaw R E, Anwar A, Schechtmann N S, Bashour T T, Stertzer S H, Zapolanski A
San Francisco Heart Institute, Seton Medical Center, Daly City, CA 94015.
Cathet Cardiovasc Diagn. 1991 May;23(1):3-9. doi: 10.1002/ccd.1810230103.
Coronary angioplasty was performed in 74 patients 80 years of age and older (mean 83 +/- 3). Single vessel coronary disease was present in 34% and multivessel coronary disease in 66%. Angioplasty of a single vessel was performed in 51 patients (69%), while 23 (31%) had angioplasty of multiple vessels. Angioplasty was successful in 59 of 74 patients (80%). Angioplasty was unsuccessful but uncomplicated in 12 (16%) due to (unyielding) calcified lesions or (impassable) old occlusions. Of these 12, 8 were discharged on medical therapy and 4 underwent elective uncomplicated bypass surgery prior to discharge. Three (4%) patients required emergency coronary bypass surgery due to abrupt vessel closure during the angioplasty procedure, with one hospital death (1.4%). Follow-up (mean 24 +/- 22 months) was obtained in all patients. Of the 59 successful angioplasty patients, late mortality was 10% (cardiac 7% and non-cardiac 3%). Survival and survival without myocardial infarction were both 90%; survival without either infarction or bypass surgery was 86%. Actuarial 3-year survival was 91% and 3-year freedom from death, infarction or bypass surgery was 87% by life-table analysis. Repeat angioplasty for restenosis was performed in 7 patients (12%) without complications.
对74名80岁及以上的患者（平均年龄83±3岁）进行了冠状动脉血管成形术。单支冠状动脉疾病患者占34%，多支冠状动脉疾病患者占66%。51名患者（69%）接受了单支血管成形术，而23名患者（31%）接受了多支血管成形术。74名患者中有59名（80%）血管成形术成功。12名患者（16%）血管成形术未成功但未出现并发症，原因是（坚硬的）钙化病变或（无法通过的）陈旧性闭塞。在这12名患者中，8名出院时接受药物治疗，4名在出院前接受了择期无并发症的搭桥手术。3名患者（4%）因血管成形术过程中血管突然闭塞而需要紧急冠状动脉搭桥手术，其中1例医院死亡（1.4%）。所有患者均获得随访（平均24±22个月）。在59名血管成形术成功的患者中，晚期死亡率为10%（心脏原因导致的占7%，非心脏原因导致的占3%）。生存率和无心肌梗死生存率均为90%；无梗死或搭桥手术的生存率为86%。通过生命表分析，3年精算生存率为91%，3年无死亡、梗死或搭桥手术的生存率为87%。7名患者（12%）因再狭窄接受了再次血管成形术，无并发症。
