Eggeling T, Hölz W, Osterhues H H, Pöhler E, Kochs M, Hombach V
Cardiology Clinic Haubrichforum, Cologne, Germany.
Coron Artery Dis. 1995 Nov;6(11):891-6.
Although there have been reports of successful percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) in elderly patients, few data are available on the optimal management of unstable angina in such patients. This study was therefore designed to identify the preferred revascularization strategy in patients with unstable angina over 75 years of age.
Early and late results were evaluated for patients over 75 years with unstable angina undergoing PTCA (n = 51) or CABG (n = 53). The two groups were comparable with respect to age, sex distribution, clinical manifestation of symptoms, left ventricular ejection fraction and accompanying non-cardiac diseases. In the CABG group, significantly more patients had left main coronary artery stenosis (13 and 2%, respectively).
Both PTCA and CABG treatment showed similar procedural success rates (91 and 94% respectively) and hospital mortality rates (4 and 6% respectively). Procedural complications were comparable regarding Q-wave myocardial infarction, stroke, renal failure and vascular complications. Patients undergoing CABG received significantly more blood transfusions than those undergoing PTCA (17 and 2% respectively). During follow-up, the mortality rate was comparable in both groups (4% with CABG and 8% with PTCA), but significantly fewer patients in the CABG group developed unstable angina (8 versus 21% in the PTCA group), fewer patients were readmitted to hospital for cardiac reasons (CABG group 17%, PTCA group 31%) and fewer patients needed repeat coronary interventions (CABG group 4%, PTCA group 18%).
Both PTCA and CABG were comparable with regard to short- and long-term mortality, but CABG treatment was favourable with regard to clinical symptoms, readmission to hospital and repeat coronary interventions.
尽管已有老年患者成功进行经皮腔内冠状动脉成形术（PTCA）和冠状动脉旁路移植术（CABG）的报道，但关于此类患者不稳定型心绞痛的最佳治疗方案，可用数据较少。因此，本研究旨在确定75岁以上不稳定型心绞痛患者首选的血运重建策略。
对75岁以上接受PTCA（n = 51）或CABG（n = 53）的不稳定型心绞痛患者的早期和晚期结果进行评估。两组在年龄、性别分布、症状临床表现、左心室射血分数和伴随的非心脏疾病方面具有可比性。在CABG组中，有左主干冠状动脉狭窄的患者明显更多（分别为13%和2%）。
PTCA和CABG治疗的手术成功率（分别为91%和94%）和住院死亡率（分别为4%和6%）相似。在Q波心肌梗死、中风、肾衰竭和血管并发症方面，手术并发症相当。接受CABG的患者输血明显多于接受PTCA的患者（分别为17%和2%）。在随访期间，两组的死亡率相当（CABG组为4%，PTCA组为8%），但CABG组发生不稳定型心绞痛的患者明显较少（PTCA组为8%，而PTCA组为21%），因心脏原因再次入院的患者较少（CABG组为17%，PTCA组为31%），需要重复冠状动脉介入治疗的患者也较少（CABG组为4%，PTCA组为18%）。
PTCA和CABG在短期和长期死亡率方面相当，但CABG治疗在临床症状、再次入院和重复冠状动脉介入治疗方面更具优势。
