Shapira I, Frimerman A, Rosenschein U, Roth A, Keren G, Laniado S, Miller H I
Department of Cardiology, Tel Aviv E. Sourasky Medical Center, Israel.
Cardiology. 1994;85(2):88-93. doi: 10.1159/000176654.
Fifty-six patients aged 75 years and older underwent percutaneous transluminal coronary angioplasty (PTCA) at our institution from 1984 to 1991. The average age was 76.7 +/- 1.5 years, and 84% of the patients were males. Single-vessel disease occurred in 21 patients, double-vessel disease in 16, and three-vessel disease in 19 patients. The mean left ventricular ejection fraction was 57 +/- 5%, and 8 patients had an ejection fraction of < 40%. The anginal functional class was I in 1 patient, II in 3, III in 6, and IV in 46 patients. Single-vessel PTCA was attempted in 43 patients, two-vessel PTCA in 8, and three-vessel PTCA in 5 patients. Revascularization was complete in 35% of the patients, incomplete in 57, and no revascularization was obtained in 8% of the patients. Ninety-one percent of the patients had a successful procedure. In 5 patients there was severe dissection, 1 patient died, 1 patient had an acute myocardial infarction, and 1 patient had emergency bypass surgery. Long-term follow-up (6-96 months, mean 21 +/- 4) in the 51 successfully treated patients revealed late cardiac death in 1 patient, repeated PTCA for restenosis in 9, and coronary bypass surgery in 2 patients. Twenty-two patients were asymptomatic, 12 had improved symptoms, and 5 remained symptomatic. PTCA appears to be a safe and effective treatment in elderly patients with one- and two-vessel disease, with excellent long-term results. Age is not a contraindication to PTCA. The results in elderly patients with three-vessel disease are less encouraging.
1984年至1991年期间，我院对56例75岁及以上的患者进行了经皮腔内冠状动脉成形术（PTCA）。平均年龄为76.7±1.5岁，84%的患者为男性。单支血管病变21例，双支血管病变16例，三支血管病变19例。左心室射血分数平均为57±5%，8例患者射血分数<40%。心绞痛功能分级：I级1例，II级3例，III级6例，IV级46例。43例患者尝试单支血管PTCA，8例尝试双支血管PTCA，5例尝试三支血管PTCA。35%的患者血运重建完全，57%不完全，8%的患者未实现血运重建。91%的患者手术成功。5例患者出现严重夹层，1例死亡，1例发生急性心肌梗死，1例接受急诊搭桥手术。对51例成功治疗的患者进行长期随访（6 - 96个月，平均21±4），发现1例患者晚期心脏死亡，9例因再狭窄重复进行PTCA，2例接受冠状动脉搭桥手术。22例患者无症状，12例症状改善，5例仍有症状。PTCA似乎是治疗老年单支和双支血管病变患者的一种安全有效的方法，长期效果良好。年龄不是PTCA的禁忌证。老年三支血管病变患者的结果不太理想。
