Kaul T K, Fields B L, Wyatt D A, Jones C R, Kahn D R
Department of Cardiac Surgery, Princeton-Baptist Medical Center, Birmingham, Alabama 35211.
Ann Thorac Surg. 1994 Nov;58(5):1419-26. doi: 10.1016/0003-4975(94)91927-5.
We retrospectively analyzed early and late results for two treatment strategies of significant coronary artery disease in 310 octogenarians seen in the last 10 years. One hundred five patients 80 or more years of age had percutaneous transluminal coronary angioplasty (PTCA) and 205 had coronary artery bypass grafting (CABG). The PTCA group differed from the CABG group in having a greater proportion of women (71.4% versus 45.8%; p < 0.001); fewer patients with unstable angina (24.7% versus 33.6%; p < 0.04), acute myocardial infarction (11% versus 23%; p < 0.04), three-vessel coronary artery disease (20% versus 56%; p < 0.0001), and a left ventricular ejection fraction less than or equal to 0.30 (10% versus 21%; p < 0.008); and fewer vessels revascularized (1.2 +/- 0.6 versus 3.5 +/- 0.9; p < 0.0001). Hospital mortality was 8.57% after PTCA (9/14 failed PTCA) and 5.8% after CABG (4/14 emergent, 6/101 urgent, and 2/90 elective). Hospital stay was 7 +/- 0.9 days after PTCA and 14 +/- 1.5 days after CABG (p < 0.01). Independent predictors of hospital mortality obtained by multivariate analysis included failed PTCA and acute myocardial infarction (PTCA group), a left ventricular ejection fraction equal to or less than 0.30, and acute myocardial infarction and emergency CABG (CABG group). Survivors after both CABG and PTCA showed a significant improvement in their New York Heart Association class. Actuarial survival at 5 years after PTCA was 55% and after CABG it was 66% (p < 0.01). Cardiac event-free survival (deaths, myocardial infarction, PTCA, CABG) at 3 years was 61% after PTCA and 81% after CABG (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
我们回顾性分析了过去10年中310名八旬老人严重冠状动脉疾病的两种治疗策略的早期和晚期结果。105名80岁及以上患者接受了经皮腔内冠状动脉成形术（PTCA），205名接受了冠状动脉旁路移植术（CABG）。PTCA组与CABG组的不同之处在于，女性比例更高（71.4%对45.8%；p<0.001）；不稳定型心绞痛患者较少（24.7%对33.6%；p<0.04），急性心肌梗死患者较少（11%对23%；p<0.04），三支冠状动脉疾病患者较少（20%对56%；p<0.0001），左心室射血分数小于或等于0.30的患者较少（10%对21%；p<0.008）；以及接受血运重建的血管较少（1.2±0.6对3.5±0.9；p<0.0001）。PTCA术后医院死亡率为8.57%（9/14例PTCA失败），CABG术后为5.8%（4/14例急诊，6/101例 urgent，2/90例择期）。PTCA术后住院时间为7±0.9天，CABG术后为14±1.5天（p<0.01）。多变量分析得出的医院死亡率独立预测因素包括PTCA失败和急性心肌梗死（PTCA组）、左心室射血分数小于或等于0.30，以及急性心肌梗死和急诊CABG（CABG组）。CABG和PTCA术后的幸存者纽约心脏协会分级均有显著改善。PTCA术后5年的精算生存率为55%，CABG术后为66%（p<0.01）。PTCA术后3年无心脏事件生存率（死亡、心肌梗死、PTCA、CABG）为61%，CABG术后为81%（p<0.01）。（摘要截断于250字）
