目的分析老年(≥65岁)无保护左主干冠状动脉病变(unprotected left main coronary disease,ULMCAD)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)的疗效。方法2004年1月至2015年12月,在阜外医院行ULMCAD-PCI治疗的患者3960例,其中1397例年龄≥65岁(老年组),2563例年龄<65岁(非老年组)。临床终点事件包括3年随访时主要不良心脏事件(major adverse cardiovascular event,MACE)、全因死亡、心肌梗死、再次血运重建的发生率。结果与非老年组相比,老年组患者的MACE(16.2%∶13.5%,P=0.002)、全因死亡(6.1%∶2.3%,P<0.0001)、心肌梗死(6.1%∶3.5%,P<0.0001)、再次血运重建(7.7%∶9.6%,P=0.04)明显升高。应用倾向性评分校正后,两组之间的MACE(危险比[HR]:1.16,95%可信区间[CI]:0.93~1.53,P=0.18)以及再次血运重建(HR:0.81,95%CI:0.61~1.06,P=0.13)无统计学差异。然而,全因死亡(HR:2.08,95%CI:1.35~3.22,P=0.0007)和心肌梗死(HR:1.73,95%CI:1.16~2.56,P=0.0056)在老年组患者中发生率更高。结论3年随访结果表明,老年无保护左主干冠状动脉疾病患者介入治疗的临床预后劣于非老年ULMCAD患者。
Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.
