Costa J Ribamar, Sousa Amanda, Moreira Adriana Costa, Costa Ricardo A, Maldonado Galo, Cano Manuel N, Egito Enilton T, Romano Edson R, Barbosa Marcos, Pavanello Ricardo, Jardim César, Cury Abrão, Berwanger Otávio, Sousa J Eduardo
Hospital do Coração - Associação do Sanatório Sírio, São Paulo, Brazil.
J Invasive Cardiol. 2008 Aug;20(8):404-10.
Despite the increasing number of elderly people, this high-complexity subset of patients is often excluded from randomized trials of percutaneous coronary intervention (PCI) and, therefore, limited data are available about their outcomes after drug-eluting stent (DES) implantation. We sought to compare the very long-term (> 1 year) clinical follow up of octogenarians treated with DES compared to younger individuals.
The DESIRE registry is a prospective, nonrandomized, single-center registry with consecutive patients treated solely with DES between May 2002 and May 2007. The only exclusion criteria were the treatment of patients in the setting of acute myocardial infarction (MI) (< 72 hours) and lesions located in non-native coronary arteries. The primary endpoint was the occurrence of combined major adverse cardiac events (MACE) (cardiac death, non-fatal MI and target vessel revascularization) in-hospital and in very long term (> 1 year) follow up. Patients were clinically evaluated at 1, 3 and 6 months and then annually up to 5 years. Stent thrombosis was classified according to the ARC definition.
A total of 1,364 patients matched the inclusion/exclusion criteria and were sorted into 3 groups according to their ages: Group I = patients < 70 years of age (n = 914); Group II = patients greater than or equal to 70 and < 80 years of age (n = 334); and Group III = patients greater than or equal to 80 years old (n = 116). As expected, octogenarians had significantly more comorbid and complex anatomic lesion presentation. Nevertheless, in-hospital success was comparable among the 3 groups. Long-term (2.6 +/- 1.2 years) follow up was obtained from 97% of the total population and showed equivalent cumulative MACE in all age ranges (7.6% for < 70 years old vs. 5.4% for septuagenarians and 6.0% for octogenarians, p = 0.7). However, octogenarians had markedly more cardiac death, reflecting the severity of their comorbidity and the natural evolution of coronary disease. Of note, very few cases of stent thrombosis were noticed in the overall population (20 patients, 1.5%), with no difference among the groups.
PCI with DES represents an efficient and safe approach to treat coronary artery disease in the elderly, with low rates of combined MACE comparable to other age ranges.
尽管老年人数量不断增加，但这类高复杂性患者亚组在经皮冠状动脉介入治疗（PCI）的随机试验中常常被排除在外，因此，关于他们在药物洗脱支架（DES）植入后的预后数据有限。我们试图比较接受DES治疗的八旬老人与较年轻个体的超长期（>1年）临床随访情况。
DESIRE注册研究是一项前瞻性、非随机、单中心注册研究，纳入2002年5月至2007年5月期间仅接受DES治疗的连续患者。唯一的排除标准是急性心肌梗死（MI）（<72小时）患者的治疗以及非自身冠状动脉病变。主要终点是住院期间及超长期（>1年）随访中发生的主要不良心脏事件（MACE）（心脏死亡、非致命性MI和靶血管血运重建）的情况。患者在1、3和6个月时进行临床评估，然后每年评估一次，直至5年。支架血栓形成根据ARC定义进行分类。
共有1364例患者符合纳入/排除标准，并根据年龄分为3组：第一组=年龄<70岁的患者（n = 914）；第二组=年龄大于或等于70岁且<80岁的患者（n = 334）；第三组=年龄大于或等于80岁的患者（n = 116）。正如预期的那样，八旬老人的合并症和复杂解剖病变表现明显更多。然而，3组患者的住院成功率相当。97%的总人群获得了长期（2.6±1.2年）随访，结果显示所有年龄组的累积MACE相当（<70岁患者为7.6%，七旬老人为5.4%，八旬老人为6.0%，p = 0.7）。然而，八旬老人的心脏死亡明显更多，这反映了他们合并症的严重程度以及冠状动脉疾病的自然发展过程。值得注意的是，总体人群中很少有支架血栓形成病例（20例患者，1.5%），各组之间无差异。
DES PCI是治疗老年冠状动脉疾病的一种有效且安全的方法，其联合MACE发生率低，与其他年龄组相当。
