JACC:复杂性冠状动脉疾病老年患者采用不同血运重建术后的10年随访结果

2021-06-11 Nebula MedSci原创

存在3根血管或左主干血管病变的老年患者无论是采用经皮冠脉介入治疗还是冠状动脉搭桥术治疗的10年全因死亡率、寿命、5年MACCE和5年QOL状态均无显著差异

全球人们的寿命都在增加,且正在步入老龄化阶段。2021年3月8日,发改委在国新办发布会上指出,预计“十四五”期间我国将进入中度老龄化阶段。

冠状动脉疾病(CAD)是导致老年患者死亡的主要原因,与年轻患者相比,老年患者的CAD往往更为复杂和严重。然而,老年复杂性冠状动脉疾病的最佳血运重建策略尚不明确。

本研究旨在调查3根血管病变(3VD)和/或左主干病变(LMD)的老年(>70岁)患者经皮冠状动脉介入治疗(PCI)或冠状动脉搭桥术(CABG)后的10年全因死亡率、寿命、5年主要不良心脑血管事件(MACCE)和5年生活质量(QOL)。

在这项SYNTAX延长生存研究中,对年龄进行了预定的分析,采用Kaplan-Meier估计和Cox比例风险模型对比老年或非老年患者的10年全因死亡率和5年MACCE。预期寿命以限定的10年内平均生存时间估计,采用线性混合效应模型评估5年内QOL状态。

10年全因死亡率

在1800位随机分组的患者中,575位(31.9%)为老年患者。老年患者采用PCI或CABG治疗的10年死亡率无显著差异(44.1% vs 41.1%; 风险比[HR]: 1.08; 95% CI

0.84-1.40),非老年患者采用两种方式治疗的10年死亡率也无显著差异(21.1% vs 16.6%; HR: 1.30; 95% CI 1.00-1.69; p=0.332)。

5年MACCE

采用PCI或CABG治疗的老年患者的5年MACCE相当(39.4% vs 35.1%; HR: 1.18; 95% CI 0.90-1.56),但是非老年患者采用PCI治疗的5年MACCE明显低于采用CABG治疗的患者(36.3% vs 23.0%; HR: 1.69; 95% CI 1.36-2.10; p=0.043)。此外,采用PCI或CABG治疗的老年患者的寿命和5年QOL也均无明显差异

综上所述,存在3根血管或左主干血管病变的老年患者无论是采用经皮冠脉介入治疗还是冠状动脉搭桥术治疗的10年全因死亡率、寿命、5年MACCE和5年QOL状态均无显著差异

原始出处:

Ono Masafumi,Serruys Patrick W,Hara Hironori et al. 10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease.[J] .J Am Coll Cardiol, 2021, 77: 2761-2773. https://doi.org/10.1016/j.jacc.2021.04.016

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    2022-04-26 hbwxf
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    2021-06-13 SR~young海东

    老年病,平时多养生

    0

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