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比较行“挽救性”经皮冠状动脉介入治疗的<75 岁与≥75 岁患者的一年预后。

Comparison of one-year outcome of patients aged <75 years versus ≥75 years undergoing "rescue" percutaneous coronary intervention.

机构信息

UO Cardiologia Interventistica Azienda ASL S. Camillo Forlanini Circonvallazione Gianicolense, Roma, Italia.

出版信息

Am J Cardiol. 2011 Oct 15;108(8):1075-80. doi: 10.1016/j.amjcard.2011.06.006. Epub 2011 Jul 24.

Abstract

The influence of age on the clinical results after rescue angioplasty (percutaneous coronary intervention [PCI]) has been poorly investigated. In the present study, we evaluated the outcome of 514 consecutive patients undergoing rescue PCI who were divided into 2 groups according to age: <75 years (n = 469) and ≥75 years (n = 45). The primary end point of the study was the incidence of death at 1 year of follow-up. The secondary end point was the 1-year incidence of major cardiac adverse events (MACE) defined as a composite of death, recurrent acute myocardial infarction, and target vessel revascularization. The predictors of death and MACE at 1 year were also investigated. At 1 year of follow-up, the <75-year-old group had a significantly lower incidence of death (7% vs 24%, p = 0.0001) and MACE (14% vs 28%, p = 0.01) compared to the ≥75-year-old group. The Cox proportional hazards model identified age (adjusted hazard ratio 0.2665, 95% confidence interval 0.1285 to 0.5524, p = 0.0004), cardiogenic shock (hazard ratio 0.1057, 95% confidence interval 0.0528 to 0.2117, p <0.000001), Thrombolysis In Myocardial Infarction flow grade 2 to 3 after PCI versus 0 to 1 (hazard ratio 3.8380, 95% confidence interval 1.7781 to 8.2843, p = 0.0006), multi- versus single-vessel disease (hazard ratio 0.3716, 95% confidence interval 0.1896 to 0.7284, p = 0.0039) as independent predictors of survival at 1 year of follow-up. In conclusion, at 1 year of follow-up after rescue PCI, the patients aged ≥75 years had a greater incidence of death and MACE compared to patients aged <75 years. Age, cardiogenic shock, Thrombolysis In Myocardial Infarction flow grade 0-1 after PCI, and multivessel coronary disease were predictors of survival and freedom from MACE at 1 year of follow-up.

摘要

年龄对挽救性经皮冠状动脉介入治疗(PCI)后临床结果的影响尚未得到充分研究。本研究评估了 514 例连续接受挽救性 PCI 的患者的结局,这些患者根据年龄分为 2 组:<75 岁(n = 469)和≥75 岁(n = 45)。研究的主要终点是 1 年随访时的死亡率。次要终点是 1 年时主要心脏不良事件(MACE)的发生率,定义为死亡、复发性急性心肌梗死和靶血管血运重建的复合终点。还研究了 1 年时死亡和 MACE 的预测因素。在 1 年的随访中,<75 岁组的死亡率(7% vs 24%,p = 0.0001)和 MACE(14% vs 28%,p = 0.01)发生率显著低于≥75 岁组。Cox 比例风险模型确定了年龄(调整后的危险比 0.2665,95%置信区间 0.1285 至 0.5524,p = 0.0004)、心源性休克(危险比 0.1057,95%置信区间 0.0528 至 0.2117,p <0.000001)、PCI 后血栓溶解心肌梗死血流分级 2-3 与 0-1(危险比 3.8380,95%置信区间 1.7781 至 8.2843,p = 0.0006)、多血管病变与单血管病变(危险比 0.3716,95%置信区间 0.1896 至 0.7284,p = 0.0039)是 1 年随访时生存的独立预测因素。总之,在挽救性 PCI 后 1 年的随访中,≥75 岁的患者与<75 岁的患者相比,死亡率和 MACE 的发生率更高。年龄、心源性休克、PCI 后血栓溶解心肌梗死血流分级 0-1 以及多支冠状动脉疾病是 1 年随访时生存和免于 MACE 的预测因素。

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