Lefèvre T, Morice M C, Eltchaninoff H, Chabrillat Y, Amor M, Juliard J M, Gommeaux A, Cattan S, Dumas P, Benveniste E
Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France.
Am J Cardiol. 1998 Jul 1;82(1):17-21. doi: 10.1016/s0002-9149(98)00236-7.
Coronary artery bypass operations are associated with increased morbidity and mortality in the elderly. Similarly, it has been shown that coronary angioplasty is associated with a higher risk of complications in the elderly than in younger patients. The purpose of this study was to evaluate the 1-month outcome of elderly patients (>75 years old) who were included in the Stenting without Coumadin French Registry. From December 1992 to March 1995, 2,900 patients (mean age 61+/-11 years) were included in this registry. All patients were treated with ticlopidine (250 to 500 mg/day) for 1 month from the day of percutaneous transluminal angioplasty, aspirin (100 to 250 mg/day) for >6 months, and low-molecular-weight heparin (antiXa 0.5 to 1 IU/ml) for 1 month in phase II, 15 days in phase III, and 7 days in phase IV. No heparin was given in phase V. The study group included 233 patients (8.0%) > 75 years old (mean age 79+/-4), 44 (18%) of whom were women. All patients underwent dilatation of a native coronary vessel. One hundred seventeen had unstable angina (50.2%), 20 had postmyocardial infarction ischemia (8.6%), and 6 had acute myocardial infarction (2.6%). Indications for stenting were de novo lesion in 63 patients (27.0%), restenosis in 38 (16.3%), suboptimal result in 48 (20.6%), nonocclusive dissection in 56 (24.0%), and occlusive dissection in 28 (12.0%), respectively. Stented coronary arteries were the left anterior descending in 109 (46.8%), the right in 80 (34.3%), the left circumflex in 40 (17.2%), and the left main in 4 (1.7%). Palmaz-Schatz stents were used in 228 patients (82.0%), AVE microstents in 38 (13.7%), and other stents in 12 (4.3%). More than 1 stent was used in 48 patients (17.3%). The mean diameter of the balloon used for stenting was 3.31+/-0.38 mm and maximal inflation pressure was 12.2+/-2.9 atm. At one-month follow-up, vascular complications occurred in 5 patients, requiring surgery in 2 (1.3%), acute closure occurred in 1 (0.4%), subacute closure in 3 (1.3%), emergency or planned coronary artery bypass graft surgery in none, acute myocardial infarction in 4 (1.7%), stroke in 1 (0.4%), and death in 8 (3.4%). The composite end point of a major cardiac event was observed in 13 cases (5.6%). Coronary stenting using ticlopidine and aspirin appears to be a particularly safe approach in this high-risk subset.
冠状动脉搭桥手术与老年人发病率和死亡率的增加相关。同样，研究表明，与年轻患者相比，冠状动脉血管成形术在老年人中出现并发症的风险更高。本研究的目的是评估纳入法国非华法林支架置入注册研究的老年患者（>75岁）1个月时的转归。1992年12月至1995年3月，共有2900例患者（平均年龄61±11岁）纳入该注册研究。所有患者从经皮腔内血管成形术当天起接受噻氯匹定（250至500mg/天）治疗1个月，阿司匹林（100至250mg/天）治疗>6个月，低分子量肝素（抗Xa 0.5至1IU/ml）在II期治疗1个月、III期治疗15天、IV期治疗7天。V期未给予肝素。研究组包括233例（8.0%）>75岁的患者（平均年龄79±4岁），其中44例（18%）为女性。所有患者均对自身冠状动脉血管进行了扩张。117例患者患有不稳定型心绞痛（50.2%），20例患者患有心肌梗死后缺血（8.6%），6例患者患有急性心肌梗死（2.6%）。支架置入的适应证分别为63例（27.0%）的初发病变、38例（16.3%）的再狭窄、48例（20.6%）的效果欠佳、56例（24.0%）的非闭塞性夹层和28例（12.0%）的闭塞性夹层。接受支架置入的冠状动脉中，左前降支109例（46.8%），右冠状动脉80例（34.3%），左旋支40例（17.2%），左主干4例（1.7%）。228例患者（82.0%）使用了Palmaz-Schatz支架，38例（13.7%）使用了AVE微型支架，12例（4.3%）使用了其他支架。48例患者（17.3%）使用了1个以上的支架。用于支架置入的球囊平均直径为3.31±0.38mm，最大膨胀压力为12.2±2.9个大气压。在1个月的随访中，5例患者出现血管并发症，2例（1.3%）需要手术治疗，1例（0.4%）发生急性闭塞，3例（1.3%）发生亚急性闭塞，无患者进行急诊或计划性冠状动脉搭桥手术，4例（1.7%）发生急性心肌梗死，1例（0.4%）发生中风，8例（3.4%）死亡。13例患者（5.6%）观察到主要心脏事件的复合终点。在这一高危亚组中，使用噻氯匹定和阿司匹林进行冠状动脉支架置入似乎是一种特别安全的方法。
