唐强,王智,曲华清,颜东,陈学智,唐群中,史震涛

• 1:北京大学首钢医院心内科

摘要(Abstract)：

目的分析75岁以上高龄ST段抬高急性心肌梗死(STEM I)急诊经皮冠状动脉介入治疗(PC I)患者住院期间的临床特征和术后12个月的随访结果。方法回顾性分析2005年3月至2010年3月,实行急诊PC I术的STEM I患者297例,年龄(59.33±11.42)岁,将高龄组(≥75岁)患者49例的临床特征、治疗结果和预后与对照组(<75岁)患者进行对比。结果高龄组患者占16.5%,年龄(77.46±2.37)岁,其中女性患者比例高于对照组(34.7%比19.8%,P<0.05)。高龄患者既往陈旧心梗、卒中较对照组多,分别是(18.3%比7.7%;30.6%比10.8%;P<0.05);其缺血时间较对照组长(4.66±2.49)h比(3.76±2.05)h,左室射血分数低(52.88±6.70)%比(55.66±7.51)%,P<0.01;高龄组冠脉介入手术成功率、并发症发生率与对照组差异无统计学意义,分别是(93.9%比97.2%,4.1%比2.0%),P>0.05;高龄组患者病变复杂,三支血管病变、术中再灌注心律失常发生率高于对照组,分别为(38.7%比23.5%;44.8%比28.6%,P<0.05)。住院期间和术后12个月两组患者在死亡、再梗死、卒中及靶血管重建率方面差异无统计学意义,术后12个月高龄组总体MACE高于对照组(22.4%比7.2%),P<0.05。结论尽管高龄组患者术后12个月的总体MACE高于对照组,但在手术成功率、并发症发生率、死亡、再梗死、卒中及靶血管重建率方面相似,急诊PC I是年龄≥75岁的高龄STEM I患者安全、有效的再灌注治疗策略。

关键词(KeyWords)： 发病年龄;心肌梗死;血管成形术,经腔,经皮冠状动脉;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 唐强,王智,曲华清,颜东,陈学智,唐群中,史震涛

参考文献(References)：

• [1]de Boer MJ,Ottervanger JP,van′t Hof AW,et al.Reperfusiontherapy in elderly patients with acute myocardial infarction:arandomized comparison of primary angioplasty and thrombolytictherapy.J Am Coll Cardiol,2002,39:1723-1728.
• [2]Keeley EC,Boura JA,Grines CL.Primary angioplasty versusintravenous thrombolytic therapy for acute myocardial infarction:A quantitative reviewof23 randomized trials.Lancet,2003,361:13-20.
• [3]Boersma Eand Primary Coronary Angioplasty vs.Thrombolysisgroup.Does time matter?A pooled analysis of randomizedclinical trials comparing primary percutaneous coronaryintervention and in-hospital fibrinolysis in acute myocardialinfarction patients.Eur Heart J,2006,27:779-788.
• [4]Rosengren A,Spetz CL,K stner M,et al.Sex differences insurvival after myocardial infarction in Sweden;data from theSwedish National Acute Myocardial Infarction Register.Eur HeartJ,2001,22:314-322.
• [5]Mehta RH,Granger CB,Alexander KP,et al.Reperfusionstrategies for acute myocardial infarction in the elderly.J AmCollCardiol,2005,45:471-478.
• [6]Devlin G,Gore JM,Elliott J,et al.GRACE Investigators.Management and 6-month outcomes in elderly and very elderlypatients with high-risk non-STelevation acute coronary syndrome:The Global Registry of Acute Coronary Events.Eur Heart J,2008,29:1275-1282.
• [7]Ogawa H,Kojima S.Modern state of acute myocardial infarctionin the interventional era:observational case-control study-Japanese acute coronary syndrome study(JACSS).J Cardiol,2009,54:1-9.
• [8]de Boer MJ,Ottervanger JP,Suryapranata H,et al.Old age andoutcome after primary angioplasty for acute myocardial infarction.J Am Geriatr Soc,2010,58:867-872.
• [9]Kashima K,Ikeda D,Tanaka H,et al.Mid-term mortality of veryelderly patients with acute myocardial infarction with or withoutcoronary intervention.J Cardiol,2010,55:397-403.
• [10]Ciszewski A,Karcz M,Kepka C,et al.Primary angioplasty inpatients≥75 years old with ST-elevation myocardial infarctionone-year follow-up results.Kardiol Pol,2008,66:828-833.