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目的评价年龄≥80岁的高龄冠心病患者血运重建治疗后的近期与远期临床结果 ,探讨远期不良事件的预测因素。方法选择接受冠状动脉血运重建治疗的冠心病患者(≥80岁)63例,记录其人口学资料、临床特征、冠状动脉造影和血运重建情况以及主要不良心脑血管事件(MACCE)。对所有患者进行电话或门诊随访,多因素Cox比例风险回归模型分析远期不良事件的预测因素。结果 85.7%的患者为多支病变。分别有81.0%和19.0%的患者接受PCI和冠状动脉旁路移植术(CABG)治疗,PCI成功率为98.0%,CABG成功率为83.3%,血管重建总成功率为95.2%。院内MACCE发生率为4.8%。中位随访时间为541(444～667)d,随访率为95.2%。总MACCE发生率为14.3%,病死率为11.1%;累积生存率为88.5%,累积无MACCE生存率为83.0%。多因素Cox分析,既往血运重建史、慢性完全闭塞病变以及是否循环支持是总MACCE的独立危险因素。结论年龄≥80岁的高龄冠心病患者接受血运重建治疗安全可行,成功率较高,院内不良事件发生率较低,远期生存率较高。
Objective To evaluate the short-term and long-term clinical outcomes of revascularization in elderly patients with coronary heart disease aged ≥ 80 years and explore the predictors of long-term adverse events. Methods Sixty-three patients with coronary heart disease (≥80 years) undergoing coronary revascularization were enrolled in this study. Their demographic data, clinical features, coronary angiography and revascularization and major adverse cardiac events (MACCE) were recorded. All patients were followed up by phone or outpatient visit, and multivariate Cox proportional hazards regression model was used to analyze the predictors of long-term adverse events. Results 85.7% of patients with multiple lesions. In 81.0% and 19.0% of patients, respectively, PCI and coronary artery bypass grafting (CABG) were performed. The success rate of PCI was 98.0%, the success rate of CABG was 83.3%, and the total success rate of revascularization was 95.2%. Hospital MACCE incidence was 4.8%. The median follow-up time was 541 (444 ~ 667) d, with a follow-up rate of 95.2%. The overall incidence of MACCE was 14.3% and the mortality rate was 11.1%. The cumulative survival rate was 88.5%, and the cumulative MACCE-free survival rate was 83.0%. Multivariate Cox analysis, history of previous revascularization, chronic total occlusion disease, and whether circulatory support were independent risk factors for total MACCE. Conclusions Coronary revascularization patients aged> 80 years old are safe and feasible to undergo revascularization. The success rate is high, the incidence of nosocomial adverse events is low, and the long-term survival rate is high.