A four-year follow-up for the prognosis of elderly patients with acute coronary syndrome after primary percutaneous coronary intervention / 中国综合临床

ABSTRACT

Objective To evaluate the clinical outcomes of PCI in elder patient four years after the operation.Methods One hundred and one elder patients with ACS were divided into two groups according to the treatment during hospitalization48 patients in the experimental group underwent primary PCI ;53 patients in control group underwent conservative treatment without PCI.For all the patients,the clinical data on admission and during the four-year follow-up were retrospectively analyzed and the incidence of cardiovascular events at different period,all-cause mortality and prognostic risk factors were compared.Results There was no statistical difference in baseline data between the two groups.The success rate of PCI in experimental group was 93.75％.Imaging examination suggested that the numbers of single vessel lesion,double- vessel lesion and three-vessel lesion were observed in 6,20 and 22 of the patients,respectively.One hundred and fifty-eight cases had lesions involved more than 70％ of the vascular diameter.The numbers of type A,B1,B2 and C vessel lesions were 12,36,48,and 62,respectively.There was no significant difference(8.33％ vs 9.43％,x2 =0.04,P =0.85 ) in the lost follow-up rates in the two groups in the four years' follow-up.The adverse cardiovascular events incidence inthe experimental group were significantly lower than that in the control group during the first 12 months after operation ( RR =2.89,x2 =3.83,P =0.05,RR95 ％ CI1.00,8.35 ).The adverse cardiac events incidence in the experimental gr?up was significantly lower than in control group during the second 12 months after speration ( RR =3.18,x2 =6.55,P =0.01,RR95 ％ CI1.09 - 9.29).There was no significant difference in the incidence of adverse cardiac events between the two groups during the 36 - 48 months after the operation.There was no significant difference in the survival rate between the two groups during the follow-up period ( x2 =2.22,P =0.14).The logistic regression analysis for the cardiac events and risk factors such as age,smoking,high blood pressure,Cr,CHO,TG,BS,UA,LDL-C and so on demonstrated that age ≥ 80 years,high blood Cr,BS,LDL-C and high blood pressure were risk factors for adverse cardiac events ( P ＜ 0.05 ).Conclusion The adverse cardiac events incidence was significantly lower in elder patients with ACS who underwent PCI in the following 24 months after operation,but there was no significant difference in terms of the long-term survival rate and adverse cardiac events incidence between the two groups.Age ≥80 years and high blood Cr,BS,LDL-C,high blood pressure were risk factors for adverse cardiac events.