CAJ | 학술논문

目的：回顾与总结经皮冠状动脉介入（PCI）治疗急性冠脉综合征（ACS）患者的临床疗效。方法选择2003年10月至2013年10月苏州市立医院北区心血管内科确诊的ACS患者543例。依据入院后手术日期分为急诊PCI组（n=236）和择期PCI组（n=307）。急诊PCI组中，老年组（≥60岁）124例，非老年组（42~59岁）112例；择期PCI组中，老年组（≥60岁）137例，非老年组（42~59岁）170例。收集患者的临床资料，包括穿刺成功率、手术成功率、手术总时间、术后并发症情况及出院后随访1年主要不良心血管事件发生情况等。结果急诊PCI组，老年组与非老年组性别比例、家族史比例、吸烟比例、心梗部位、罪犯血管、血脂、左室射血分数比较无统计学差异（P均＞0.05）。老年组较非老年组，糖尿病、高血压比例增加，总胆固醇降低，差异有统计学意义（P均＜0.05）。择期PCI组，老年组与非老年组性别比例、家族史比例、心梗部位、罪犯血管、血脂、左室射血分数比较，无统计学差异（P均＞0.05）。老年组较非老年组，糖尿病、高血压、吸烟比例增加，差异有统计学意义（P均＜0.05）。急诊PCI组以及择期PCI组，老年组与非老年组穿刺成功率、手术成功率、手术总时间、造影剂量、住院期间再次血运重建以及随访1年再次心梗、再次行血运重建术比较，无统计学差异（P均＞0.05）。急诊PCI组，老年组较非老年组，住院期间死亡比例增加，随访1年死亡、心力衰竭增加，差异有统计学意义（P均＜0.05）。结论 PCI治疗是ACS有效的治疗手段，但其对老年ACS患者远期预后的影响仍需进一步探讨。
목적：회고여총결경피관상동맥개입（PCI）치료급성관맥종합정（ACS）환자적림상료효。방법선택2003년10월지2013년10월소주시립의원북구심혈관내과학진적ACS환자543례。의거입원후수술일기분위급진PCI조（n=236）화택기PCI조（n=307）。급진PCI조중，노년조（≥60세）124례，비노년조（42~59세）112례；택기PCI조중，노년조（≥60세）137례，비노년조（42~59세）170례。수집환자적림상자료，포괄천자성공솔、수술성공솔、수술총시간、술후병발증정황급출원후수방1년주요불양심혈관사건발생정황등。결과급진PCI조，노년조여비노년조성별비례、가족사비례、흡연비례、심경부위、죄범혈관、혈지、좌실사혈분수비교무통계학차이（P균＞0.05）。노년조교비노년조，당뇨병、고혈압비례증가，총담고순강저，차이유통계학의의（P균＜0.05）。택기PCI조，노년조여비노년조성별비례、가족사비례、심경부위、죄범혈관、혈지、좌실사혈분수비교，무통계학차이（P균＞0.05）。노년조교비노년조，당뇨병、고혈압、흡연비례증가，차이유통계학의의（P균＜0.05）。급진PCI조이급택기PCI조，노년조여비노년조천자성공솔、수술성공솔、수술총시간、조영제량、주원기간재차혈운중건이급수방1년재차심경、재차행혈운중건술비교，무통계학차이（P균＞0.05）。급진PCI조，노년조교비노년조，주원기간사망비례증가，수방1년사망、심력쇠갈증가，차이유통계학의의（P균＜0.05）。결론 PCI치료시ACS유효적치료수단，단기대노년ACS환자원기예후적영향잉수진일보탐토。
Objective To retrospect and summarize the curative effect of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).Methods ACS patients (n=543) were chosen from Oct. 2003 to Oct. 2013, and then divided into emergency PCI group (n=236) and selective PCI group (n=307). Emergency PCI group was divided again into elderly group 1 (aged≥60,n=124) and non-elderly group 1 (aged from 42 to 59, n=112), and selective PCI group was divided again into elderly group 2 (aged≥60,n=137) and non-elderly group 2 (aged from 42 to 59,n=170). The clinical data were collected from all patients including puncture success rate, PCI success rate, PCI total time, complications after PCI, and major adverse cardiovascular events (MACE) after 1-year follow-up.Results Between elderly group 1 and non-elderly group 1, the percentages of sex, medical history and smoking, locations of myocardial infarction (MI), culprit vessels, blood fat and LVEF had no statistical difference (allP>0.05). The percentages of patients with diabetes and hypertension increased and total cholesterol (TC) level decreased in elderly group 1 compared with non-elderly group 1 (allP<0.05). Between elderly group 2 and non-elderly group 2, the percentages of sex and medical history, locations of MI, culprit vessels, blood fat and LVEF had no statistical difference (allP>0.05). The percentages of patients with diabetes, hypertension and smoking cases increased in elderly group 2 compared with non-elderly group 2 (allP<0.05). The comparison in puncture success rate, PCI success rate, PCI total time, contrast agent dosage, re-revascularization during hospitalization, and re-MI and revascularization procedure during 1-year follow-up had no statistical difference between elderly group 1 and non-elderly group 1 or between elderly group 2 and non-elderly group 2 (allP>0.05). The percentage of died cases, and mortality and heart failure during 1-year follow-up had statistical difference between elderly group 1 and non-elderly group 1 (allP<0.05).Conclusion PCI is an effective therapy for ACS, but its influence on long-term prognosis in elderly patients with ACS needs further discussion.