Rigattieri Stefano, Cera Maria, Sciahbasi Alessandro, Di Russo Cristian, Fedele Silvio, Ferraiuolo Giuseppe, Altamura Giuliano, Pugliese Francesco Rocco, Loschiavo Paolo
1Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy.
J Invasive Cardiol. 2013 May;25(5):242-5.
Little is known about the efficacy and medium-term outcomes of primary percutaneous coronary intervention (PCI) in very old patients. We evaluated in-hospital and 6-month outcomes in a retrospective cohort of nonagenarian patients presenting at our hospital with ST-segment elevation myocardial infarction (STEMI) and treated by primary PCI from January 2003 to May 2012. During this period, primary PCI was performed in 1598 consecutive patients; twenty-seven patients (age, 92.5 ± 2.5 years) were enrolled in the study. Four patients (15%) were in advanced Killip class at presentation. STEMI location was anterior in 44%. Patients received aspirin, 300 mg clopidogrel loading dose, and heparin. Abciximab was given to 41% of patients. Coronary angiography showed multivessel disease in 52% of patients. Pain-to-balloon and door-to-balloon times were 375.0 ± 410.2 minutes and 107.3 ± 47.6 minutes, respectively. Intra-aortic balloon pump was implanted in 1 patient. An average of 1.3 ± 0.7 stents (95% bare-metal stents) were implanted per patient. Procedural success rate, defined as Thrombolysis in Myocardial Infarction (TIMI) flow grade ≥ 2 and residual stenosis <20%, was 89%. Hospital mortality was 18.5%. TIMI major bleeding and acute renal failure, defined as an absolute increase of 0.5 mg/dL serum creatinine, occurred in 7% and 22% of patients, respectively. Overall 6-month survival rate was 67%. Our data suggest that primary PCI can be performed in nonagenarian patients with high success rate and with an acceptable bleeding risk, even when aggressive antithrombotic drugs, such as glycoprotein IIb/IIIa inhibitors, are given.
关于高龄患者直接经皮冠状动脉介入治疗（PCI）的疗效和中期预后，目前所知甚少。我们对2003年1月至2012年5月在我院因ST段抬高型心肌梗死（STEMI）接受直接PCI治疗的非agenarian患者的回顾性队列进行了住院和6个月预后评估。在此期间，连续1598例患者接受了直接PCI；27例患者（年龄92.5±2.5岁）纳入研究。4例患者（15%）就诊时处于高级Killip分级。STEMI部位位于前壁的占44%。患者接受阿司匹林、300mg氯吡格雷负荷剂量和肝素治疗。41%的患者给予阿昔单抗。冠状动脉造影显示52%的患者有多支血管病变。疼痛至球囊时间和门至球囊时间分别为375.0±410.2分钟和107.3±47.6分钟。1例患者植入了主动脉内球囊泵。每位患者平均植入1.3±0.7枚支架（95%为裸金属支架）。定义为心肌梗死溶栓（TIMI）血流分级≥2且残余狭窄<20%的手术成功率为89%。住院死亡率为18.5%。TIMI严重出血和急性肾衰竭（定义为血清肌酐绝对增加0.5mg/dL）分别发生在7%和22%的患者中。总体6个月生存率为67%。我们的数据表明，即使给予糖蛋白IIb/IIIa抑制剂等积极的抗血栓药物，非agenarian患者也可以进行直接PCI，成功率高且出血风险可接受。
