Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong; Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia.
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
Value Health. 2018 Apr;21(4):423-431. doi: 10.1016/j.jval.2017.10.004. Epub 2017 Nov 10.
Impact of percutaneous coronary interventions (PCI) on health-related quality of life (HRQOL) is important but under-reported in elderly patients.
To evaluate long-term health status in elderly patients who underwent PCI.
Consecutive patients who underwent PCI at a university-affiliated hospital from September 2009 to June 2012 were prospectively enrolled with HRQOL assessment at baseline (up to 2 weeks before PCI) and at 6-, 12-, and 36-month follow-up using the EuroQol five-dimensional questionnaire descriptive profile and visual analogue scale (VAS). Minimally important benefit (MIB) in HRQOL was defined as greater than half an SD improvement in the baseline VAS score.
Of 1957 patients, 49.9%, 29.1%, and 21.0% were aged younger than 65 years, 65 to 74 years, and 75 years and older, respectively. Mean VAS scores at baseline (50.1 ± 20.5 vs. 51.6 ± 20.5 vs. 52.6 ± 21.8; P = 0.09) and at 36 months (72.9 ± 14.0 vs. 72.8 ± 16.1 vs. 72.0 ± 14.8; P = 0.77) were similar between the three age groups, respectively. MIB at 36 months was observed in 65.7%, 61.9%, and 61.2% of patients in each age group, respectively. Proportion of patients aged 75 years and older reporting problems in pain/discomfort and self-care reduced from 91.2% and 24.8% at baseline to 41.4% and 10.1% at 36 months, respectively (both P < 0.01). Independent predictors of MIB in HRQOL at 36 months in patients 75 years and older included poor baseline HRQOL, MIB at 6 months, and presentation with myocardial infarction (all P < 0.01).
Elderly patients experienced sustained long-term improvement in quality of life comparable with younger patients after PCI. Our findings suggest that age per se should not deter against revascularization because of sustained benefit in HRQOL.
经皮冠状动脉介入治疗（PCI）对健康相关生活质量（HRQOL）的影响很重要，但在老年患者中的报告不足。
评估在大学附属医院接受 PCI 的老年患者的长期健康状况。
连续前瞻性招募 2009 年 9 月至 2012 年 6 月在大学附属医院接受 PCI 的患者，在基线（PCI 前最多 2 周）和 6、12 和 36 个月随访时使用欧洲五维健康量表简表和视觉模拟量表（VAS）进行 HRQOL 评估。HRQOL 的最小重要获益（MIB）定义为基线 VAS 评分提高超过半标准差。
1957 例患者中，年龄<65 岁、65-74 岁和≥75 岁的患者分别占 49.9%、29.1%和 21.0%。三组基线 VAS 评分（50.1±20.5 比 51.6±20.5 比 52.6±21.8；P=0.09）和 36 个月 VAS 评分（72.9±14.0 比 72.8±16.1 比 72.0±14.8；P=0.77）相似。三组患者 36 个月 MIB 分别为 65.7%、61.9%和 61.2%。基线时报告疼痛/不适和自理问题的≥75 岁患者比例分别从 91.2%和 24.8%降至 36 个月时的 41.4%和 10.1%（均 P<0.01）。75 岁及以上患者 36 个月时 HRQOL MIB 的独立预测因素包括基线 HRQOL 差、6 个月时 MIB 和心肌梗死表现（均 P<0.01）。
PCI 后，老年患者的生活质量长期持续改善，与年轻患者相当。我们的研究结果表明，年龄本身不应成为阻止血管重建的因素，因为 HRQOL 持续获益。
