Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
Nat Rev Cardiol. 2011 Feb;8(2):79-90. doi: 10.1038/nrcardio.2010.184. Epub 2010 Dec 7.
In contemporary practice, more than one in five patients treated with percutaneous coronary intervention (PCI) are aged ≥75 years and the proportion of elderly individuals in the population is growing. The elderly have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients needing PCI and, therefore, derive greater benefit from revascularization. However, they are also more likely to experience procedural complications, owing to age-related physiological changes, frailty, and comorbidities. This article reviews the outcomes of revascularization among the elderly and the impact of advances in PCI techniques and adjuvant pharmacotherapy on these outcomes. We also address clinical challenges that exist presently when considering PCI in the elderly, as well as future research needs to optimize revascularization outcomes in this population. To maximize the benefits of PCI in the elderly, providers should have explicit conversations with patients regarding goals of treatment. Once a decision to undergo PCI is reached, clinicians need to individualize care decisions, address modifiable risks such as bleeding, and pay careful attention to selection of the appropriate timing of PCI, and the type, timing, and dosing of adjuvant medical therapy.
在当代实践中，接受经皮冠状动脉介入治疗 (PCI) 的患者中，超过五分之一的患者年龄≥75 岁，并且人口中老年人的比例正在增加。与需要 PCI 的年轻患者相比，老年人有更多的心血管危险因素和更大的缺血性疾病负担，因此从血运重建中获益更大。然而，由于与年龄相关的生理变化、虚弱和合并症，他们更容易发生手术并发症。本文回顾了老年人血运重建的结果，以及 PCI 技术和辅助药物治疗的进步对这些结果的影响。我们还讨论了目前在考虑对老年人进行 PCI 时存在的临床挑战，以及优化该人群血运重建结果的未来研究需求。为了使老年人从 PCI 中获得最大收益，医务人员应与患者明确讨论治疗目标。一旦决定进行 PCI，临床医生就需要个体化护理决策，解决可改变的风险，如出血，并仔细注意选择适当的 PCI 时机，以及辅助药物治疗的类型、时机和剂量。
