Richardson M, Pitney M R, Gibbons F, Cope G D, Cumpston G N, Mews G C
Department of Cardiology, Royal Perth Hospital, WA, England.
Aust N Z J Med. 1994 Feb;24(1):55-60. doi: 10.1111/j.1445-5994.1994.tb04427.x.
This report reviews the outcome of percutaneous transluminal coronary angioplasty (PTCA) on patients aged 75 years or over at this institution, in order to provide statistics that may be useful in managing elderly patients.
All elderly patients undergoing PTCA between January 1984 and December 1990 were included. Data concerning the PTCA procedure and short term (hospital stay) outcome were compared to those of all patients less than 75 years who underwent PTCA during the same period. Long term outcome was obtained for all surviving elderly patients.
One hundred and eleven procedures were performed on patients over 75 years, compared to 3183 procedures on patients under 75. The incidence of PTCA in the elderly increased to 6.7% of all procedures in 1990. Elderly patients were more symptomatic (97% vs 79% in patients under 75 years had Canadian Cardiovascular Society grade 3 or 4 angina), more frequently had the procedure performed urgently (39% vs 14%) and often (67%) had risk factors for PTCA (3 vessel disease, significant left ventricular dysfunction, or a complicating medical illness). Primary success rates (86% vs 90% in patients under 75 years), urgent coronary artery bypass grafting (1.8% vs 1.9%) and Q wave infarction (1.8% vs 1.0%) were similar in the two age groups. In the elderly, procedural difficulties requiring non standard equipment were common (61%), and in-hospital mortality was increased (4.5% vs 0.7%). Additionally, three patients died after discharge resulting in a 30 day mortality of 7.2%. A favourable long term outcome was obtained in 50% of patients at a mean follow up of 20 months. Unfavourable or neutral outcome was due to one or more of the following; death (16%), coronary artery bypass grafting (19%), acute myocardial infarction (7.5%) or significant residual angina (17%).
Highly symptomatic patients over 75 years constitute a high risk group for PTCA, with approximately half obtaining a favourable long term outcome.
本报告回顾了本院75岁及以上患者经皮腔内冠状动脉成形术（PTCA）的治疗结果，以便提供有助于老年患者管理的统计数据。
纳入1984年1月至1990年12月期间接受PTCA的所有老年患者。将PTCA手术及短期（住院）结果的数据与同期接受PTCA的所有75岁以下患者的数据进行比较。对所有存活的老年患者获得长期结果。
75岁以上患者进行了111例手术，75岁以下患者进行了3183例手术。1990年老年患者PTCA的发生率增至所有手术的6.7%。老年患者症状更明显（97%的75岁以上患者与79%的75岁以下患者有加拿大心血管学会3级或4级心绞痛），更频繁地进行急诊手术（39%对14%），且经常（67%）有PTCA的危险因素（三支血管病变、严重左心室功能障碍或并发内科疾病）。两个年龄组的主要成功率（75岁以下患者为90%，75岁以上患者为86%）、急诊冠状动脉旁路移植术（1.9%对1.8%）和Q波梗死（1.0%对1.8%）相似。在老年患者中，需要非标准设备的手术困难很常见（61%），住院死亡率增加（4.5%对0.7%）。此外，3例患者出院后死亡，导致30天死亡率为7.2%。平均随访20个月时，50%的患者获得了良好的长期结果。不良或中性结果归因于以下一种或多种情况：死亡（16%）、冠状动脉旁路移植术（19%）、急性心肌梗死（7.5%）或严重残余心绞痛（17%）。
75岁以上症状严重的患者是PTCA的高危人群，约一半患者获得良好的长期结果。
