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目的分析老年(≥65岁)冠心病患者接受血运重建后影响其预后的因素。方法6005例接受了血运重建,包括经皮冠脉介入治疗(PCI)和冠状动脉搭桥(CABG)的冠心病患者根据年龄分为两组,老年组(≥65岁,3728例)和对照组(<65岁,2277例),对患者进行电话或门诊随访,随访的中位数为555d,比较两组间临床情况和预后。结果两组间血运重建总死亡率和MACCE发生率差异有统计学意义,其中总死亡率(老年组与对照组)为3.5%与1.6%(P=0.001),MACCE为12%与3.9%(P=0.001)。与对照组相比,老年患者合并高血压、糖尿病以及脑血管病史、陈旧心梗史的发生率明显要高,而ST段抬高心梗、三支病变、左主干病变、CTO发生率也明显高,内生肌酐清除率、完全血运重建率却低。Cox多因素回归分析发现,糖尿病(HR2.011,95%CI1.093～3.697,P=0.027)、三支血管病变(HR2.036,95%CI1.123～3.813,P=0.017)、老年(≥65岁,HR5.605,95%CI2.001～15.705,P<0.001)是总死亡率增加的独立危险因素,而内生肌酐清除率(HR1.923,95%CI1.107～3.203,P=0.013)、左主干病变(HR1.877,95%CI1.193～2.978,P=0.001)、三支血管病变(HR1.515,95%CI1.243～1.806,P=0.007)是MACCE发生率增加的独立危险因素。结论糖尿病、三支血管病变、老年(≥65岁)是老年冠心病患者血运重建后总死亡率增加的独立危险因素,而内生肌酐清除率、左主干病变、三支血管病变是MACCE发生率增加的独立危险因素。
Objective To analyze the factors affecting the prognosis of elderly patients (≥65 years old) with coronary heart disease after revascularization. Methods Six hundred and sixty five patients undergoing revascularization were enrolled in this study. Patients with coronary artery disease, including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), were divided into two groups according to their ages: the elderly group (≥65 years old, 3728 cases) and the control group (<65 years old, 2277 cases). Patients were followed up by telephone or outpatient visits. The median follow-up was 555 days. The clinical situation and prognosis were compared between the two groups. Results There was significant difference between the two groups in the total mortality of revascularization and the incidence of MACCE. The overall mortality rate was 3.5% in the elderly group and 1.6% in the control group (P = 0.001). The MACCE was 12% and 3.9% (P = 0.001). Compared with the control group, elderly patients with hypertension, diabetes and cerebrovascular history, the incidence of obstructive myocardial infarction was significantly higher, and ST-segment elevation myocardial infarction, three lesions, left main disease, CTO incidence was also significantly High, endogenous creatinine clearance, complete revascularization rate is low. Cox multivariate regression analysis showed that there was no significant difference in the incidence of diabetes (HR 2.011, 95% CI 1.093-3.697, P = 0.027), three vessel diseases (HR 2.036, 95% CI 1.123-3.813, P = 0.017) ≥65 years old, HR5.605, 95% CI2.001 ~ 15.705, P <0.001) was an independent risk factor for the increase of total mortality, while the clearance rate of endogenous creatinine (HR1.923, 95% CI 1.107-3.203, P (HR1.877,95% CI1.193-2.978, P = 0.001). The incidence of MACCE in three vessel lesions (HR 1.515, 95% CI 1.243 ~ 1.806, P = 0.007) Increased independent risk factors. Conclusions Diabetes mellitus, three-vessel disease and senile (≥65 years old) are independent risk factors for the increase of total mortality after coronary revascularization in elderly patients with coronary artery disease. Endogenous creatinine clearance, left main trunk disease, Rate of increase of independent risk factors.