Am J Cardiol：老年慢性完全闭塞病变患者行PCI可改善生存

　　日本一项研究表明，在老年患者中，因慢性完全闭塞病变（CTO）而实施的经皮冠状动脉介入（PCI）操作的成功率较高，并且可改善心脏性生存率。论文于6月3日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项观察性研究共纳入284例因CTO接受PCI治疗的患者，并回顾性对比评估≥75岁老年组（67例）和<75岁年轻组（217例）患者的相关特征。

　　结果显示，老年组和年轻组的操作成功率分别为77%和79%，并且在操作并发症发生率方面无显著差异。在老年组中，成功实施PCI者的3年心脏性生存率显著高于失败者（97.6%对76.9%）。在年轻组中，PCI成功者和失败者的3年心脏性生存率基本相似。多变量分析显示，在老年组中成功PCI与心源性死亡发生率较低具有相关性[危险比（HR）为0.09，P= 0.042]。

Comparison of Short- and Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions Between Patients Aged ≥75 Years and Those Aged <75 Years
Abstract
Few reports are available on the safety and efficacy of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) in older patients. In the present study, 284 patients who underwent PCI for CTOs were retrospectively evaluated by comparing the characteristics of 67 patients aged ≥75 years (the older group) and 217 patients aged <75 years (the younger group). Technical success was achieved in 77% of the patients in the older group and 79% of those in the younger group (p = 0.66). No significant differences were observed between the 2 groups in terms of the incidence of procedural complications. In the older group, a comparison between the patients with successful and failed PCI revealed significantly superior 3-year cardiac survival (97.6% vs 76.9%, p = 0.005). The 3-year cardiac survival of those with successful PCI was similar to that observed in the younger group. On multivariate analysis, successful PCI was found to be associated with a lower incidence of cardiac death in the older group (hazard ratio 0.09, 95% confidence interval 0.01 to 0.91, p = 0.042). In conclusion, this single-center, observational study suggests that PCI for CTOs can be performed with a high rate of procedural success and acceptably low mortality and morbidity in older patients, resulting in improved cardiac survival. Thus, PCI for CTO lesions should be included among the treatment strategies for older patients.