Thompson R C, Holmes D R, Grill D E, Mock M B, Bailey K R
Division of Cardiovascular Diseases, Mayo Clinic Jacksonville, Florida, USA.
J Am Coll Cardiol. 1996 Jan;27(1):8-14. doi: 10.1016/0735-1097(95)00436-X.
This study sought to determine whether in-hospital and intermediate-term posthospital outcomes have changed in elderly patients undergoing percutaneous transluminal coronary angioplasty from the period 1980 through 1989 to the period 1990 through 1992.
Although elderly patients have a higher incidence of procedure-related deaths and late recurrence of angina after coronary angioplasty, recent complication rates for angioplasty seem to be lower.
From 1980 to 1989, 982 patients > or = 65 years old underwent nonemergent coronary angioplasty (group A). They were compared with 768 similar patients who had coronary angioplasty from 1990 to 1992 (group B).
Patients in group B were older than those in group A and had a higher mean concomitant disease score, a higher proportion of men and a greater proportion of patients with a previous myocardial infarction and previous coronary artery bypass surgery. Despite the increased complexity of the group B cohort, procedural success rates were higher, and rates of important in-hospital complications were much lower than those in group A. For group A versus group B, respectively, the technical success rate was 88.1% versus 93.5% (p < 0.001), in-hospital death rate 3.3% versus 1.4% (p = 0.014), emergency bypass surgery rate 5.5% versus 0.65% (p < 0.001) and incidence of in-hospital death or myocardial infarction 6.3% versus 3.4% (p < 0.005). However, intermediate-term posthospital event-free rates in hospital survivors did not decrease. The rate of death or myocardial infarction at 6 months was 4.7% in group A versus 7.1% in group B (p < 0.05). Survival free of acute myocardial infarction, bypass surgery, repeat coronary angioplasty or severe angina at 1 year was 66.7% in group A versus 54.9% in group B (p < 0.001). The combined in-hospital death/myocardial infarction rate plus that for the first 6 months after hospital dismissal was essentially equivalent for the two groups (10.3% vs. 9.9%, p = NS).
An increase in technical success rates and a reduction in short-term complication rates for coronary angioplasty in the elderly in recent years have not translated into an improved event-free survival rate, which continues to be influenced by important baseline characteristics of these high risk patients.
本研究旨在确定1980年至1989年期间与1990年至1992年期间接受经皮腔内冠状动脉成形术的老年患者的院内及中期院后结局是否发生了变化。
尽管老年患者冠状动脉成形术后与手术相关的死亡及心绞痛晚期复发发生率较高，但近期成形术的并发症发生率似乎较低。
1980年至1989年，982例年龄≥65岁的患者接受了非急诊冠状动脉成形术（A组）。将他们与1990年至1992年接受冠状动脉成形术的768例类似患者进行比较（B组）。
B组患者比A组患者年龄更大，平均伴随疾病评分更高，男性比例更高，既往有心肌梗死和既往冠状动脉搭桥手术的患者比例更大。尽管B组队列的复杂性增加，但手术成功率更高，重要的院内并发症发生率远低于A组。A组与B组相比，技术成功率分别为88.1%对93.5%（p<0.001），院内死亡率3.3%对1.4%（p = 0.014），急诊搭桥手术率5.5%对0.65%（p<0.001），院内死亡或心肌梗死发生率6.3%对3.4%（p<0.005）。然而，院内存活者的中期院后无事件发生率并未降低。A组6个月时的死亡或心肌梗死发生率为4.7%，B组为7.1%（p<0.05）。A组1年时无急性心肌梗死、搭桥手术、重复冠状动脉成形术或严重心绞痛的生存率为66.7%，B组为54.9%（p<0.001）。两组的院内死亡/心肌梗死合并率加上出院后前6个月的合并率基本相当（10.3%对9.9%，p = 无显著性差异）。
近年来老年患者冠状动脉成形术的技术成功率提高及短期并发症率降低并未转化为无事件生存率的改善，无事件生存率仍受这些高危患者重要基线特征的影响。
