Babunashvili A M, Dundua D P, Kartashov D S, Bazarnova A A, Korenevich A Yu, Vetluzhskikh M E
Multidisciplinary Clinic Center of Endosurgery and Lithotripsy, Moscow, Russia.
Kardiologiia. 2016 Jul;56(7):54-62. doi: 10.18565/cardio.2016.7.54-62.
to assess immediate and long-term results of coronary angioplasty and stenting in patients older than 80 years - a high risk group in view of the severity of concomitant pathology and extent of coronary atherosclerosis.
We conducted retrospective analysis of data from 167 patients older than 80 years (mean age 81.43+/-2.14 years) subjected to percutaneous coronary intervention from 2006 to 2013 (3.2% from total number of patients). Multivessel involvement was present in 128 patients (76.6%) including 20 (12.4%) with stenosis in left main coronary artery. In 215 out of 270 stenotic lesions complicated stenoses type B2, C were detected . Number of chronic occlusions was 31 (10.3%) out of 301 treated lesions. There were 46 patients (27.5%) with diabetes, 16 (9.6%) with chronic anemia, 35 (21%) with chronic renal failure. Concomitant multifocal lesions in other arterial beds were found in 67 patients (40.1%). Radial, femoral, and combined femoral-radial accesses was used in 157 (94%), 5 (3%), and 5 (3%) patients, respectively. Results were studied with the help of automated system of digital computer angiography and intracoronary ultrasound. Long-term results were assessed with the help of questioning, control angiography, and echocardiography.
Immediate angiographic and clinical success was achieved in 97 and 94% of cases, respectively. Revascularization was complete in 62.2% of cases. Hospital mortality was 0.7%. Major adverse cardiac events (MACE) were registered in 4.6 and 22.4% of patients during periods of 30 days and >24 months, respectively. Stent thrombosis was diagnosed in 3 cases (1.79%) in 6-18 months after intervention. Repeat revascularization in remote period was performed in 20 patients (12.8%), in 8 of them because of appearance of new lesion. Survival after 40 months was 91%, survival without MACE after 60 months was 74.8%. Complications related to access artery was 4.2% (1.9% in 157 transradial Interventions). According of logistic regression analysis, the following predictors of MACE in remote period were determined: initial depressed left ventricular function, diabetes mellitus, and lesion length >35 mm.
Coronary angioplasty and stenting is an effective method of treatment of coronary atherosclerosis in patients older than 80 years with acceptable rate of MACE. Radial access lowers rate of access related vascular complications.
评估80岁以上患者冠状动脉血管成形术和支架置入术的近期及长期效果——鉴于其合并症的严重程度和冠状动脉粥样硬化的范围，这是一个高危群体。
我们对2006年至2013年期间接受经皮冠状动脉介入治疗的167例80岁以上患者（平均年龄81.43±2.14岁）的数据进行了回顾性分析（占患者总数的3.2%）。128例患者（76.6%）存在多支血管病变，其中20例（12.4%）左主干冠状动脉狭窄。在270处狭窄病变中，215处合并B2型、C型复杂狭窄。在301处治疗病变中，慢性闭塞病变有31处（10.3%）。46例患者（27.5%）患有糖尿病，16例（9.6%）患有慢性贫血，35例（21%）患有慢性肾衰竭。67例患者（40.1%）在其他动脉床发现合并多灶性病变。分别有157例（94%）、5例（3%）和5例（3%）患者采用桡动脉、股动脉及股-桡动脉联合入路。借助数字计算机血管造影和冠状动脉内超声自动系统研究结果。通过问诊、对照血管造影和超声心动图评估长期结果。
分别有97%和94%的病例取得了即刻血管造影和临床成功。62.2%的病例血运重建完全。医院死亡率为0.7%。在30天和超过24个月期间，分别有4.6%和22.4%的患者发生主要不良心脏事件（MACE）。干预后6至18个月，3例（1.79%）被诊断为支架血栓形成。远期有20例患者（12.8%）进行了再次血运重建，其中8例是由于出现新病变。40个月后的生存率为91%，60个月无MACE的生存率为74.8%。与入路动脉相关的并发症为4.2%（157例经桡动脉介入中为1.9%）。根据逻辑回归分析，确定了远期MACE的以下预测因素：初始左心室功能降低、糖尿病和病变长度>35mm。
冠状动脉血管成形术和支架置入术是治疗80岁以上冠状动脉粥样硬化患者的有效方法，MACE发生率可接受。桡动脉入路降低了与入路相关的血管并发症发生率。
