CAJ | 학술논문

目的：通过分析老年冠状动脉慢性闭塞病变(coronary chronic total occlusion,CTO)患者接受介入治疗后的临床特点及预后情况,探讨不同年龄段的老年 CTO 患者行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的可行性和安全性。方法回顾性分析我院2012年7月至2014年6月住院行 PCI 治疗的老年 CTO 患者共211例,按年龄分为高龄老年组73例,年龄≥75岁,平均(80.9±3.4)岁；老年组138例,年龄60~75岁,平均(68.3±5.7)岁；并以同期106例行 PCI 的中青年 CTO 患者为非老年组,年龄<60岁,平均(51.3±6.9)岁,比较3组患者的临床特点、冠状动脉造影血管病变程度、血管开通率、围手术期并发症及预后情况等。结果3组的CTO 靶血管迂曲和(或)钙化的比例随年龄增加而升高,高龄老年组及老年组的比例均高于非老年组,两两比较差异有统计学意义(P <0.05)；高龄老年组与 PCI 相关的心肌梗死的发生率较老年组及非老年组高(P <0.05),但3组患者的冠状动脉病变血管数目、闭塞病变位置、闭塞病变开通率、随访术后主要心血管事件发生率差异均无统计学意义(P >0.05)。结论不同年龄段的老年 CT0患者行 PCI 治疗的手术成功率及预后情况与非老年组 CTO 患者相当,老年 CTO 病变的介入治疗可行；但老年患者血管迂曲钙化较非老年患者严重,应警惕并发症。
목적：통과분석노년관상동맥만성폐새병변(coronary chronic total occlusion,CTO)환자접수개입치료후적림상특점급예후정황,탐토불동년령단적노년 CTO 환자행경피관상동맥개입(percutaneous coronary intervention,PCI)치료적가행성화안전성。방법회고성분석아원2012년7월지2014년6월주원행 PCI 치료적노년 CTO 환자공211례,안년령분위고령노년조73례,년령≥75세,평균(80.9±3.4)세；노년조138례,년령60~75세,평균(68.3±5.7)세；병이동기106례행 PCI 적중청년 CTO 환자위비노년조,년령<60세,평균(51.3±6.9)세,비교3조환자적림상특점、관상동맥조영혈관병변정도、혈관개통솔、위수술기병발증급예후정황등。결과3조적CTO 파혈관우곡화(혹)개화적비례수년령증가이승고,고령노년조급노년조적비례균고우비노년조,량량비교차이유통계학의의(P <0.05)；고령노년조여 PCI 상관적심기경사적발생솔교노년조급비노년조고(P <0.05),단3조환자적관상동맥병변혈관수목、폐새병변위치、폐새병변개통솔、수방술후주요심혈관사건발생솔차이균무통계학의의(P >0.05)。결론불동년령단적노년 CT0환자행 PCI 치료적수술성공솔급예후정황여비노년조 CTO 환자상당,노년 CTO 병변적개입치료가행；단노년환자혈관우곡개화교비노년환자엄중,응경척병발증。
ABSTRACT:Objective To analyze the clinical features and prognosis in elderly patients with chronic total occlusion (CTO)receiving percutaneous coronary intervention (PCI),and to explore the feasibility and safety of PCI in elderly patients with CTO.Methods Two hundred and eleven elderly patients with CTO comfirmed by coronary angiography and treated with PCI from July 2012 to June 2014 in Tongji Hospital were retrospectively analyzed.All patients were divided into two groups according to age,very elderly group (age≥75 years old,mean 80.9±3.4 years old,73 cases)and eldely group (age from 60 to 75 years old,mean 68.3±5.7 years old,138 cases).A total of 106 cases with CTO treated with PCI under the age of 60 were selected as young group and retrospectively analyzed (mean 5 1.3±6.9 years old).Clinical characteristics vascular lesions in coronary angiography,recanalization rate of occlusive vessels,perioperative complications and prognosis were analyzed and compared among three groups.Results The incidence of tortuosity and/or calcification increased sharply with age and was significantly higher in very elderly group and elderly group than in young group (P <0.05 ).The rate of PCI-associated myocardial infarction in very elderly group was significantly higher than that of other two groups (P < 0.05 ). However,there were no significant difference in the number and the location of occlusive vessel branches,the recanalization rate of occlusive vessel and the incidence of main cardiovascular event among three groups (P < 0.05 ).Conclusion There were no significant difference in the success rate of PCI and the prognosis of main cardiovascular event between elderly patients with CTO and young patients with CTO.PCI is feasible and safe in elderly patients with CTO.