Drug-eluting stents in octogenarians: early and intermediate outcome.

背景：大型随机临床试验已经显示，常规应用药物洗脱支架进行经皮冠状动脉介入治疗（PCI）是安全有效的。但是高龄患者（80岁以上）经常被这些试验排除。

方法：我们连续分析了美国Mayo Clinic（罗彻斯特, 明尼苏达州）2453例行DES置入的患者，这些患者按年龄分为两组：≥80岁患者和≤79岁的患者。

结果：≥80岁的患者明显有更多不良基线特征，包括更多并存疾病，和更严重的广泛冠脉疾病。两组操作成功率都较高：≥80岁的患者成功率为97%，而较低龄患者为98%。多变量分析显示，≥80岁的患者更易发生院内主要心脏不良事件（MACEs）（P=0.004）。另外，80岁以上的患者随访MACE率更高（P <0.001）。在12个月随访时，≥80岁的患者死亡率为8.9%，而较低龄患者死亡率为3.0%(P < .001)。高龄患者心肌梗死复发率更高（5.2% vs 2.6%, P = 0.019）。但是，12个月靶病变血运重建（TLR）(4.5% vs 4.9% [≥ 80 yrs of age vs ≤79 yrs of age])和冠脉旁路移植率（CABG）(1.8% vs 1.3% [≥80 yrs of age vs ≤ 79 yrs of age])没有显著差异。调整了年龄-性别因素后，高龄患者的预期寿命与一般人群相似（P = 0.78）

结论：这项研究表明，虽然基线风险特征更严重，但是与相对年轻的患者相比，高龄患者药物洗脱支架的置入操作成功率高。在随访期间，死亡率和整体MACE率仍然更高但是靶病变血运重建率是相似的。

（医心网编辑 刘瑞琦 编译 付世娜 审校）

来源：Am Heart J. 2008 Apr;155(4):680-6.

Drug-eluting stents in octogenarians: early and intermediate outcome.

BACKGROUND: Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials.

METHODS: We analyzed 2453 consecutive patients who underwent DES implantation at the Mayo Clinic. The patients were classified in 2 age groups: patients > or = 80 years of age < or = 79 years of age.

RESULTS: Patients > or = 80 years old had significantly more adverse baseline characteristics including more comorbid conditions and more severe extensive coronary artery disease. Procedural success was high irrespective of the age group--97% in patients > or = 80 years of age versus 98% in the younger patients. Multivariate analysis demonstrated that age of > or = 80 years was significantly associated with inhospital major adverse cardiac events (MACEs) (P = .004). In addition, among inhospital survivors, octogenarians also had higher follow-up MACE rates (P < .001). At 12 months of follow-up, patients > or = 80 years of age had a mortality of 8.9% versus 3.0% for the younger patients (P < .001). The older patients also had more recurrent myocardial infarction (5.2% vs 2.6%, P = .019). However, there was no significant difference in 12-month target lesion revascularization (4.5% vs 4.9% [> or = 80 years of age vs < or = 79 years of age]) or coronary artery bypass grafting (1.8% vs 1.3% [> or = 80 years of age vs < or = 79 years of age]). After age-sex adjustment, life expectancy of octogenarians was similar to that of the general population (P = .78).

CONCLUSION: This study showed that drug-eluting stent implantation in octogenarians has high initial procedural success rates compared with the younger patients despite having more severe baseline risk characteristics. During follow-up, death and overall MACE rates remain higher in octogenarians but target lesion revascularization rates are similar.     

source：Am Heart J. 2008 Apr;155(4):680-6.