Ricou F J, Suilen C, Rothmeier C, Gisselbaek A, Urban P
Cardiology Center, University Hospital, Geneva, Switzerland.
Am J Med. 1995 Jul;99(1):16-21. doi: 10.1016/s0002-9343(99)80099-0.
To determine the risks and the consequences of coronary angiography performed on octogenarians with symptomatic coronary artery disease.
In order to define angiographic findings, procedural complications, and therapeutic consequences, a retrospective evaluation was made of 115 consecutive patients with angina, aged 80 or above, who underwent coronary angiography in our institution between 1988 and 1992.
In all, 115 patients (68 men) aged 82 +/- 2 years, 70% with unstable angina, underwent coronary angiography corresponding to 1.4% of all the procedures performed between 1988 and 1992. Three-vessel or left main coronary artery disease, or both, was found in 42% of cases, but this proportion decreased over the years. Revascularization by means of percutaneous transluminal angioplasty (PTCA) or bypass grafting followed angiography in 54% of cases. Use of revascularization has markedly increased, from 33% in 1988 to 64% in 1992 (P < 0.05), and now tends to be performed more often by PTCA. Eight patients (7%) suffered minor periprocedural complications and 8 patients (7%) died in the hospital, but none of the deaths was directly related to the diagnostic procedure itself. At follow-up (28 +/- 16 months), 68% and 44% of the survivors were free of angina after revascularization and medical treatment, respectively (P < 0.05), and there was a nonsignificant trend for better survival after revascularization. Of the survivors, 80% were able to pursue an independent life.
Coronary angiography may be done in symptomatic octogenarians with an acceptably low complication rate. Following diagnostic evaluation, revascularization procedures are performed in an increasing proportion of patients, and despite a relatively high procedural complication rate, they result in definite symptomatic improvement.
确定对有症状的冠状动脉疾病的八旬老人进行冠状动脉造影的风险及后果。
为明确血管造影结果、手术并发症及治疗后果，对1988年至1992年间在我院接受冠状动脉造影的115例连续的80岁及以上心绞痛患者进行了回顾性评估。
共有115例患者（68例男性），年龄82±2岁，70%为不稳定型心绞痛，接受了冠状动脉造影，占1988年至1992年间所有手术的1.4%。42%的病例发现三支血管病变或左主干冠状动脉病变，或两者皆有，但这一比例多年来有所下降。54%的病例在血管造影后通过经皮腔内血管成形术（PTCA）或搭桥手术进行血运重建。血运重建的使用显著增加，从1988年的33%增至1992年的64%（P<0.05），目前PTCA进行血运重建的频率更高。8例患者（7%）出现轻微围手术期并发症，8例患者（7%）在医院死亡，但无一例死亡与诊断程序本身直接相关。在随访（28±16个月）时，分别有68%和44%的幸存者在血运重建和药物治疗后无心绞痛（P<0.05），血运重建后生存情况有改善的趋势，但无统计学意义。在幸存者中，80%能够独立生活。
对于有症状的八旬老人，冠状动脉造影可以进行，并发症发生率可接受。经过诊断评估后，越来越多的患者接受血运重建手术，尽管手术并发症发生率相对较高，但症状有明确改善。
