Varani Elisabetta, Aquilina Matteo, Balducelli Marco, Vecchi Giuseppe, Frassineti Valeria, Maresta Aleardo
Department of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy.
Catheter Cardiovasc Interv. 2009 Mar 1;73(4):449-54. doi: 10.1002/ccd.21852.
To review the results of PCI in patients aged >or=80 years.
Octogenarians represent a growing proportion of patients treated with PCI; in this subset of high-risk patients, the role of complete revascularization is still controversial.
We examined in-hospital, 30 days, and 12-month events in 356 patients aged >or=80 years submitted to PCI from 2004 to 2006 and 754 patients aged <80 years treated in 2006.
Octogenarians had a higher risk profile. A complete revascularization was obtained in 48% of them and in 65% of younger patients (P < 0.001); glycoprotein IIb/IIIa inhibitors (GPI) use was common in both groups (43 vs. 46.5%). In-hospital mortality was higher in octogenarians (3.9 vs. 1.3%, P = 0.01) as well as vascular complications (2.8 vs. 1%, P = 0.058). Mortality resulted 5.9 vs. 1.2% at 30 days (P < 0.001), and 16.3 vs. 3.9% at 12 months (P <0.001) in the two groups whereas repeat revascularization procedures did not differ (9.3 vs. 8.4%, respectively). In patients aged >or=80, there was no difference in 12 months total events (20 vs. 28%, P = 0.07) and repeat revascularizations (8 vs. 10%, P = 0.498) in completely or uncompletely revascularized subjects. At multivariate analysis age (P = 0.002), diabetes (P = 0.002), three vessel disease (P = 0.020) and procedural success (P = 0.002) were independent predictors of total events at 12 months.
In our experience, frequent GPI use and multivessel PCI in 41% of >or=80 years-old patients resulted in good immediate and mid-term clinical outcomes, irrespective of the completeness of revascularization achieved.
回顾年龄≥80岁患者的经皮冠状动脉介入治疗（PCI）结果。
在接受PCI治疗的患者中，八旬老人所占比例日益增加；在这一高危患者亚组中，完全血运重建的作用仍存在争议。
我们调查了2004年至2006年接受PCI治疗的356例年龄≥80岁患者以及2006年治疗的754例年龄<80岁患者的住院、30天及12个月事件。
八旬老人具有更高的风险特征。他们中48%实现了完全血运重建，而年轻患者中这一比例为65%（P<0.001）；两组中糖蛋白IIb/IIIa抑制剂（GPI）的使用都很常见（43%对46.5%）。八旬老人的住院死亡率更高（3.9%对1.3%，P = 0.01），血管并发症发生率也更高（2.8%对1%，P = 0.058）。两组在30天时的死亡率分别为5.9%和1.2%（P<0.001），12个月时分别为16.3%和3.9%（P<0.001），而再次血运重建手术无差异（分别为9.3%和8.4%）。在年龄≥80岁的患者中，完全或未完全血运重建的患者在12个月时的总事件（20%对28%，P = 0.07）和再次血运重建（8%对10%，P = 0.498）无差异。多因素分析显示，年龄（P = 0.002）、糖尿病（P = 0.002）、三支血管病变（P = 0.020）和手术成功率（P = 0.002）是12个月时总事件的独立预测因素。
根据我们的经验，在41%的年龄≥80岁患者中频繁使用GPI和进行多支血管PCI可带来良好的近期和中期临床结果，无论血运重建是否完全实现。
