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目的 观察直接经皮冠状动脉内介入 (PCI)对高龄ST段抬高的急性心肌梗死 (STEMI)患者临床预后的影响。方法 STEMI连续行直接PCI的患者 1 56例 ,对IRA行直接PCI。随访 1～ 1 2个月患者主要心血管事件 (MACE)的发生率。结果 ≥ 75岁组较 <75岁组中脑卒中比例较高 (P <0 0 5) ,患者发病至再灌注时间延长 (P <0 0 5) ,左室射血分数 (LVEF)降低 (P <0 0 5)。共随访 1 4 5例患者 ,两组住院期发生非致命性再次心肌梗死差异无显著性 ,但≥ 75岁组心脏性死亡增高 (9 4%比1 8% ,P <0 0 5) ;随访平均 (7 3± 3 2 )个月 ,≥ 75岁组患者总心脏性病死率明显高于 <75岁组(1 2 5 %比 1 8% ,P <0 0 5)。多变量logistic回归分析提示年龄≥ 75岁与LVEF值降低分别与STEMI患者行直接PCI后心脏性死亡增加密切相关 ,是心脏性死亡事件危险增高的独立预测变量。结论 年龄≥ 75岁因素可能是STEMI患者行直接PCI后心脏性死亡增加的独立预测因子
Objective To investigate the clinical effect of direct percutaneous coronary intervention (PCI) on the clinical prognosis of elderly patients with ST-elevation acute myocardial infarction (STEMI). Methods One hundred fifty-six consecutive patients underwent STEMI with direct PCI and direct PCI with IRA. Follow-up 1 ~ 12 months in patients with major cardiovascular events (MACE) incidence. Results The stroke rate was higher in patients aged 75 years and younger than 75 years (P <0.05), and the duration of reperfusion was prolonged (P <0 05). The left ventricular ejection fraction (LVEF) was decreased <0 0 5). A total of 154 patients were followed up. There was no significant difference in non-fatal myocardial infarction between the two groups during hospitalization, but cardiac death was higher in ≥ 75 years group (94.4% vs 18%, P <0.05). Follow-up Mean (73 ± 32) months, ≥75 years of age patients with total cardiac mortality was significantly higher than <75 years old group (115% vs 18%, P <0 05). Multivariate logistic regression analysis indicated that age ≥ 75 years and decreased LVEF were closely related to the increase of cardiac death after direct PCI in patients with STEMI, respectively, and were independent predictors of the increased risk of cardiac death. Conclusions Age ≥ 75 years may be an independent predictor of increased cardiac death in STEMI patients after direct PCI