CAJ | 학술논문

目的：经皮冠状动脉介入治疗术（ percutaneous transluminal coronary intervention， PCI）可有效改善急性心肌梗死（ acute myocardial infarction， AMI）患者的缺血症状和预后，降低近期死亡率，但针对PCI应用于高龄AMI患者的研究较少。文中评价高龄（≥75岁） AMI患者急诊PCI的有效性与近期安全性。方法收集2012年1月至2013年12月连续入住南京军区南京总医院行急诊PCI的AMI患者213例，按年龄分为高龄组（≥75岁，n＝57）与非高龄组（＜75岁，n＝156）。对2组患者的临床资料及冠状动脉介入特点进行回顾性分析。结果与非高龄组比较，高龄组患者以呼吸困难和疲乏等心功能不全为首发症状者多见（21．1％vs 3．2％，P＜0．01）、女性比例高（47．4％vs 16．7％，P＜0．01），合并高血压、糖尿病者比例高。2组急诊PCI治疗即刻成功率高（均达100％），高龄组手术相关并发症发生率（3．5％）、主要心脏不良事件发生率（8．8％）及院内死亡率（5．3％）分别与非高龄组的2．6％、6．4％和2．6％比较，差异均无统计学意义（ P＞0．05）。结论高龄AMI患者的不典型临床症状多见，急诊PCI治疗高龄AMI可有效地使梗死相关动脉再通，成功率高，并发症少，近期预后良好。
목적：경피관상동맥개입치료술（ percutaneous transluminal coronary intervention， PCI）가유효개선급성심기경사（ acute myocardial infarction， AMI）환자적결혈증상화예후，강저근기사망솔，단침대PCI응용우고령AMI환자적연구교소。문중평개고령（≥75세） AMI환자급진PCI적유효성여근기안전성。방법수집2012년1월지2013년12월련속입주남경군구남경총의원행급진PCI적AMI환자213례，안년령분위고령조（≥75세，n＝57）여비고령조（＜75세，n＝156）。대2조환자적림상자료급관상동맥개입특점진행회고성분석。결과여비고령조비교，고령조환자이호흡곤난화피핍등심공능불전위수발증상자다견（21．1％vs 3．2％，P＜0．01）、녀성비례고（47．4％vs 16．7％，P＜0．01），합병고혈압、당뇨병자비례고。2조급진PCI치료즉각성공솔고（균체100％），고령조수술상관병발증발생솔（3．5％）、주요심장불량사건발생솔（8．8％）급원내사망솔（5．3％）분별여비고령조적2．6％、6．4％화2．6％비교，차이균무통계학의의（ P＞0．05）。결론고령AMI환자적불전형림상증상다견，급진PCI치료고령AMI가유효지사경사상관동맥재통，성공솔고，병발증소，근기예후량호。
Objective Percutaneous coronary intervention( PCI) is effective in improving the ischemia and prognosis of pa-tients with acute myocardial infarction ( AMI) to reduce the short-term mortality.However, little research has been done on PCI in eld-erly AMI patients.The study aimed to evaluate the efficacy and the safety of percutaneous coronary intervention in elderly AMI patients (≥75 years old) . Methods 213 AMI patients who underwent emergency PCI in Jingling Hospital from January 2012 to December 2013 were divided into 2 groups:elderly group (≥75 years old, n=57) and non-elderly group (<75years old,n=156).Retrospec-tive analysis were made on the clinical data and the coronary intervention features of the patients. Results There were more patients having dyspnea, fatigue and other heart failure symptoms at the onset of first-break AMI in elderly group than in non-elderly group (21.1%vs 3.2%,P<0.0).More women (47.4% vs 16.7%,P<0.01) and more patients with hypertention or diabetes mellitus were found in elderly group.The procedure success rates with TIMI-3 flow grade of post-PCI in both groups were very high (100%). Compared with non-elderly group, the occurrence of the procedure-related complications (3.5%vs 2.6%,P=NS) and major adverse cardiac event rates (8.8%vs 6.4%,P=NS) and in-hospital mortality (5.3%vs 2.6%,P=NS) showed no significant difference.Conclusion There are more atypical clinical symptoms in elderly AMI patients. The emergency PCI in elderly AMI patients can effectively make artery unimpeded with high successful rate, few com-plications and a favorable short-term prognosis.