Victorian Heart Centre, Epworth Hospital, Melbourne, Australia.
Heart Lung Circ. 2011 Oct;20(10):622-8. doi: 10.1016/j.hlc.2010.08.012. Epub 2010 Oct 5.
There are very few data about percutaneous coronary intervention (PCI) in very elderly patients. This study was aimed at assessing the demographic, clinical and angiographic features, procedural characteristics and in-hospital results of very elderly patients (VEP), aged ≥85 years undergoing PCI and comparing their results with those of a control group (CG) of patients younger than 85 years undergoing PCI throughout the same period of time.
Between November 2004 and January 2007, 1699 consecutive PCI procedures were evaluated, 102 (6%) PCI procedures were performed in VEP and 1597 (94%) in patients <85 years. The mean age in the VEP group was 87.4 ± 2.4 years vs. 66.7 ± 11.2 years in the CG (p<0.0001). There were more females in the VEP group 49% vs. 22% than in the CG p<0.0001. Acute coronary syndromes (ACS) were a more frequent indication for PCI in VEP than in the CG: ST segment elevation myocardial infarction (STEMI) 14.7% vs. 8.3%, p = 0.025 and non-ST segment elevation acute coronary syndromes 54.9% vs. 43.5%, p = 0.024. The proportion of drug-eluting stents used, although high in both groups, was lower in VEP than in the CG (86.5% vs. 92.9%, p = 0.005). Angiographic lesion success rates were similar in both groups (95.9%). Global unadjusted in-hospital mortality was higher in the VEP group in comparison with the CG 3.9% vs. 0.68%, p = 0.01. The difference in mortality was due only to PCI in patients presenting with STEMI (26.6% in VEP group vs. 3.7% in the CG p = 0.007). There were no in-hospital deaths in VEP presenting with stable coronary syndromes or other ACS. There were no differences in unadjusted in-hospital myocardial infarction, new revascularisation or stroke between both groups.
In patients ≥85 years old, PCI seems effective and carries an acceptable in-hospital mortality rate. The presence of STEMI substantially increases the risk of in-hospital death.
关于高龄患者（≥85 岁）行经皮冠状动脉介入治疗（PCI）的相关数据非常有限。本研究旨在评估高龄患者（VEP）行经皮冠状动脉介入治疗的人口学、临床和血管造影特征、手术特征和住院期间结果，并与同期行 PCI 的年龄<85 岁的对照组（CG）患者的结果进行比较。
2004 年 11 月至 2007 年 1 月期间，共评估了 1699 例连续 PCI 手术，其中 102 例（6%）在 VEP 中进行，1597 例（94%）在年龄<85 岁的患者中进行。VEP 组的平均年龄为 87.4±2.4 岁，CG 组为 66.7±11.2 岁（p<0.0001）。VEP 组女性比例为 49%，高于 CG 组的 22%（p<0.0001）。ACS 是 VEP 患者 PCI 的更常见适应证，比 CG 组高：ST 段抬高型心肌梗死（STEMI）14.7%比 8.3%，p=0.025 和非 ST 段抬高型急性冠状动脉综合征 54.9%比 43.5%，p=0.024。两组均使用了大量药物洗脱支架，但 VEP 组的使用率低于 CG 组（86.5%比 92.9%，p=0.005）。两组的血管造影病变成功率相似（95.9%）。与 CG 组（0.68%）相比，VEP 组的全球未经调整的住院死亡率更高（3.9%），p=0.01。死亡率的差异仅归因于 STEMI 患者的 PCI（VEP 组 26.6%，CG 组 3.7%，p=0.007）。在 VEP 组中，稳定型冠状动脉综合征或其他 ACS 患者无院内死亡。两组未经调整的住院期间心肌梗死、再血管化或卒中等并发症无差异。
在年龄≥85 岁的患者中，PCI 似乎有效，且具有可接受的住院死亡率。STEMI 的存在显著增加了住院期间死亡的风险。
