CAJ | 학술논문

目的：探究经皮冠状动脉介入治疗（PCI）围手术期联合应用替罗非班抗血小板治疗，对不同年龄急性冠状动脉综合征（ACS）患者的有效性及安全性。方法回顾性地收集解放军总医院老年心内科2011年1月至2012年12月确诊为ACS，围术期均用小剂量替罗非班，并植入药物洗脱支架（DES）的患者302例（男性207例，女性95例），根据年龄分为老年组（≥65岁，n＝155）和中青年组（＜65岁，n＝147）。比较两组患者PCI术后30d内主要及次要终点事件的发生率，并用多因素logistic回归分析终点事件发生的相关危险因素。结果（1）老年组主要终点事件发生率明显高于中青年组[26（16.7%）vs 7（4.8%），P＝0.001]。（2）30d随访期间两组患者均未出现颅内出血，消化道出血两组各1例，老年组发生轻微出血事件24例（15.5%），中青年组6例（4.2%），P＝0.001。（3）多因素logistic回归分析表明，年龄≥65岁、女性、吸烟史、糖尿病、高脂血症、既往PCI史为30d内主要终点事件发生的独立危险因素。（4）女性、吸烟史、糖尿病与30d内各种出血事件成正相关，老龄、高脂血症、既往PCI史不是出血并发症发生的预测因素。结论围术期应用替罗非班强化抗血小板治疗，老年组患者主要终点事件及轻微出血事件的发生率均高于中青年组，提示对老年患者介入治疗过程中强化抗血小板治疗需慎重。
목적：탐구경피관상동맥개입치료（PCI）위수술기연합응용체라비반항혈소판치료，대불동년령급성관상동맥종합정（ACS）환자적유효성급안전성。방법회고성지수집해방군총의원노년심내과2011년1월지2012년12월학진위ACS，위술기균용소제량체라비반，병식입약물세탈지가（DES）적환자302례（남성207례，녀성95례），근거년령분위노년조（≥65세，n＝155）화중청년조（＜65세，n＝147）。비교량조환자PCI술후30d내주요급차요종점사건적발생솔，병용다인소logistic회귀분석종점사건발생적상관위험인소。결과（1）노년조주요종점사건발생솔명현고우중청년조[26（16.7%）vs 7（4.8%），P＝0.001]。（2）30d수방기간량조환자균미출현로내출혈，소화도출혈량조각1례，노년조발생경미출혈사건24례（15.5%），중청년조6례（4.2%），P＝0.001。（3）다인소logistic회귀분석표명，년령≥65세、녀성、흡연사、당뇨병、고지혈증、기왕PCI사위30d내주요종점사건발생적독립위험인소。（4）녀성、흡연사、당뇨병여30d내각충출혈사건성정상관，노령、고지혈증、기왕PCI사불시출혈병발증발생적예측인소。결론위술기응용체라비반강화항혈소판치료，노년조환자주요종점사건급경미출혈사건적발생솔균고우중청년조，제시대노년환자개입치료과정중강화항혈소판치료수신중。
ObjectiveTo assess the efficacy and safety of combined applicationoftirofibanwith percutaneous coronary intervention (PCI)in acute coronarysyndromes(ACS)patientsatdifferentages in perioperative period.MethodsA retrospective studywas carried out for consecutive ACS patients receiving low-dose tirofiban in perioperative period and undergoingPCI and drug-eluting stents (DES) implantation in our department from Jan. 2011 to Dec. 2012. A total of302 patients(207 males and 95 females) were recruited in this study, and were divided into 2 groups according to their ages: the elderly group (≥65 years,n=155) and the young and middle aged group(age<65 years, n=147). The incidences of primary andsecondaryendpointsofamajorcardiovascularevent were compared between the 2 groups within 30 d after the PCI.Multiplelogistic regression analysiswas used toanalyze the risk factorsfor the endpoints.Results(1)Among the 302 patients, theincidence ofprimary endpointswassignificantly higher in the elderly group than in the young and middle aged group [26(16.7%)vs 7(4.8%),P=0.001].(2)No serious acute intracranial bleeding occurred in the2 groups.Each group had 1 case of gastrointestinal bleeding [1(0.7%)vs1(0.6%),P=1.000]. While, there were24 patients(15.5%)havingminimal bleeding eventsfromthe elderly group and 6 patients(4.2%) from the young and middle aged group (P=0. 001). (3) Multiplelogistic regression analysisindicated thataged over 65 years,female,history of smoking, diabetes mellitus, hyperlipidemia,andprior history of PCI weretheindependent risk factors of the primary endpoints inboth groups duringthe30-day follow-up. (4)Female, history of smoking,anddiabetes mellituswere positively correlated with bleeding complications, while aging, hyperlipidemia, and prior history of PCI were not the independent predictive factors of bleeding events.ConclusionCombined applicationoftirofiban in perioperative period of PCI results insignificantincreases in the incidences of primary endpoints and minimal bleeding events intheelderly thaninthe young and middle agedpatients, which suggests that the antiplatelet medication of tirofiban should be prudently conductedfor the elderly.