85岁以上急性冠脉综合征患者接受经皮冠状动脉支架置入术的长期预后：裸金属支架与药物洗脱支架的比较

Long-term outcome of patients of over 85 years old with acute coronary syndrome undergoing percutaneous coronary stenting: a comparison of bare metal stent and drug eluting stent.

作者信息

Ma Han-ying, Zhou Yu-jie, Dick Ronald J, Shi Dong-mei, Liu Yu-yang, Cheng Wan-jun, Guo Yong-he, Wang Jian-long, Ge Hai-long

机构信息

12th Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

出版信息

Chin Med J (Engl). 2008 May 20;121(10):887-91.

PMID:18706201

Abstract

BACKGROUND

Patients aged over 85 years have been under-represented in percutaneous coronary intervention (PCI) trials despite an increase in referrals for PCI. The long-term safety and efficacy of percutaneous coronary stenting in patients aged over 85 years with acute coronary syndrome (ACS) remain unclear. Moreover it is unknown whether there are differences between bare metal stent (BMS) and drug eluting stent (DES) in this special population.

METHODS

A total of 80 patients with ACS aged over 85 years undergoing stenting (BMS group n = 21 vs DES group n = 59) were retrospectively studied. In-hospital, one year and overall clinical follow-up (12 - 36 months) of major adverse cardiac events (MACEs) including cardiac deaths, myocardial infarction, target lesion revascularization (TLR) and target vessel revascularization (TVR) as well as stroke and other major bleeding were compared between the two groups.

RESULTS

In the entire cohort, the procedure success rate was 93.8% with TIMI-3 coronary flow post-PCI in 93.8% of the vessels and the procedure related complication was 17.5%. The incidence of in-hospital MACEs in BMS group was higher (14.3% vs 6.8%, P = 0.30). The 1-year incidence of MACEs in DES group was 7.0% while there was no MACE in the BMS group. Clinical follow-up for 12 - 36 months showed that the overall survival free from MACE was 82.9% and the incidence of MACE in the BMS group was lower (5.3% vs 21.1%, P = 0.20). Multivariate regression analysis showed that the creatinine level (OR: 1.013; 95% CI: 1.006 - 1.020; P = 0.004) and hypertension (OR: 3.201; 95% CI: 1.000 - 10.663; P = 0.04) are two major factors affecting the long-term MACE.

CONCLUSIONS

Percutaneous coronary stenting in patients aged over 85 years is safe and provides good short and long-term efficacy. Patients with renal dysfunction and hypertension may have a relatively high incidence of MACE.

摘要

背景

尽管经皮冠状动脉介入治疗（PCI）转诊人数有所增加，但85岁以上患者在PCI试验中的代表性不足。85岁以上急性冠状动脉综合征（ACS）患者经皮冠状动脉支架置入术的长期安全性和有效性仍不明确。此外，在这一特殊人群中，裸金属支架（BMS）和药物洗脱支架（DES）之间是否存在差异尚不清楚。

方法

对80例年龄超过85岁的ACS患者进行支架置入术（BMS组n = 21，DES组n = 59）进行回顾性研究。比较两组患者住院期间、1年及总体临床随访（12 - 36个月）的主要不良心脏事件（MACE），包括心源性死亡、心肌梗死、靶病变血运重建（TLR）和靶血管血运重建（TVR）以及中风和其他大出血情况。

结果

在整个队列中，手术成功率为93.8%，PCI术后93.8%的血管TIMI-3级冠状动脉血流，手术相关并发症发生率为17.5%。BMS组住院期间MACE发生率较高（14.3%对6.8%，P = 0.30）。DES组1年MACE发生率为7.0%，而BMS组无MACE发生。12 - 36个月的临床随访显示，无MACE的总体生存率为82.9%，BMS组MACE发生率较低（5.3%对21.1%，P = 0.20）。多因素回归分析显示，肌酐水平（OR：1.013；95%CI：1.006 - 1.020；P = 0.004）和高血压（OR：3.201；95%CI：1.000 - 10.663；P = 0.04）是影响长期MACE的两个主要因素。