| BackgroundWith the prosperity of social economy,the rapid development of science and technology,people’s life is gradually becoming richer,the level of medical standards is not what it used to be,the aging process of our country’s population has accelerated year by year.Moreover,with the constant changes in medical technology,human life expectancy has also increased gradually,the growth rate of the elderly population aged 65 and above is also increasing.On March 11,2021,Premier Li Keqiang said in Press Conference of the Fourth Session of the 13th National People’s Congress that our country’s aging population has reached 260 million.Then comes the health problems of the elderly.In recent years,the prevalence of coronary heart disease(CHD)has been rising rapidly.The population of elderly patients with coronary heart disease(≥65 years old)is even increasing.One of the final outcomes of the gradual progression of coronary heart disease is chronic total occlusions(CTO).CTO is also one of the common types of complex lesions in clinical work and life.As we all know,one of the common and important methods for the treatment of coronary heart disease is percutaneous coronary intervention(PCI).In recent years,due to the technical improvements of stents,the advancements of medical technology,the accumulation of rich clinical experience,and the application of circulatory assist devices,PCI has been widely used in cardiology clinical treatment and has achieved good results.Most domestic and foreign observational and retrospective studies showed that successful CTO-PCI can improve patients’ clinical symptoms and the occurrence of major adverse cardiovascular events(MACE),improve left ventricular function and myocardial remodeling,and improve the quality of life.However,due to the high difficulty of this type of operation,long operation time,high radiation dose,large amount of contrast agent,low success rate,high intraoperative and postoperative complications,and other shortcomings and difficulties,at present,the application of PCI for CTO is not widely used.Moreover,elderly patients may have more underlying diseases;coronary occlusion lesions are relatively long,and severe vascular calcification,which makes it more difficult for elderly CTO patients to successfully undergo PCI treatment,so there are fewer studies in this area.ObjectiveTo investigate the effects and prognosis of percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease combined with chronic total occlusion(CTO).MethodsA total of 270 patients(age≥65 years old)were selected from the hospital medical record data system,all of whom were treated in the Department of Cardiology,The First Affiliated Hospital of Zhengzhou University from January 2018 to December 2018.The CTO lesion was confirmed by coronary angiography and the course of disease was more than 3 months.Among them,140 patients in the combined treatment group(PCI group)which were successfully treated by PCI and given optimal medical therapy,and the remaining 130 patients were treated by optimal medical therapy and included in the control group(OMT group).Collected the general data,coronary artery lesions,and related examination and inspection indicators of 270 patients before and after surgery,and analyzed and compared the ultrasound cardiogram index,symptom improvement,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)level of the two groups at baseline,6 months,and 12 months after treatments.And the incidences of major adverse cardiovascular events during follow-up.Results1.Comparison of baseline data of two groups.General information of the two groups of patients:such as age,sex ratio,smoking history,whether it was combined with hypertension,type 2 diabetes,etc.and past history of myocardial infarction,past coronary therapy,family history,characteristics of coronary artery disease,the ultrasound cardiogram index,and related serological indexes.The baseline data of two groups were compared and there was no statistically significant difference(P>0.05).2.After clinical intervention treatment,both groups of patients achieved certain curative effect.①After 6 months of treatment,41 cases(31.54%)in the OMT group improved in symptoms,61 cases(43.57%)in the PCI group improved;61 cases(46.92%)in the OMT group improved after 12 months of treatment,and 86 cases(61.43%)in the PCI group improved.The comparative analysis showed that the symptom improvement rates of PCI group were higher than that of OMT group after 6 and 12 months of treatments,and the differences were both statistically significant(P<0.05).②Intra-group comparison:After 6 months of treatment,the LVEF in the OMT group was improved(50.60±6.01 vs 49.62±5.04),and the FS was improved(30.42±2.08 vs 29.34±1.42),but the difference wasn’t statistically significant;the LVEDD(50.90±2.97 vs 51.99±2.93,P<0.05)and NT-proBNP[476.00(230.00,843.02)vs 541.00(246.25,1007.00),P<0.05]both decreased,and the differences were statistically significant.In the PCI group,LVEF(52.07±5.10 vs 49.87±6.08,P<0.05)and FS(31.37±2.03 vs 29.64±1.31,P<0.05)increased,LVEDD(50.33±3.00 vs 52.18±2.66,P<0.05)and NT-proBNP[335.00(199.75,736.00)vs.666.53(286.23,1095.00),P<0.05]decreased compared to the baseline,and the differences were all statistically significant.After 12 months of treatment,the LVEF in the OMT group improved(51.88±5.00 vs 49.62±5.04,P<0.05);FS increased(31.65±1.35 vs 29.34±1.42,P<0.05),LVEDD(49.32±2.94 vs 51.99±2.93,P<0.05),NT-proBNP[343.00(187.25,625.00)vs 541.00(246.25,1007.00),P<0.05]both decreased compared with baselines,the differences were statistically significant.LVEF(53.81±5.13 vs 49.87±6.08,P<0.05)and FS(33.02±1.48 vs 29.64±1.31,P<0.05)in PCI group improved compared with before treatment,LVEDD(48.42±2.93 vs 52,18±2.66,P<0.05)And NT-proBNP[288.23(189.00,421.84)vs 666.53(286.23,1095.00),P<0.05]were all decreased compared with the previous period,and the differences were statistically significant.③Comparison between the two groups:After 6 months of treatment,the LVEF(52.07±5.10 vs 50.60±6.01,P<0.05),FS(31.37±2.03 vs 30.42±2.08,P<0.05)and NT-proBNP[335.00(199.75,736.00)vs 476.00(230.00,843.02),P<0.05]data of PCI group improved better than OMT group,and the differences were statistically significant.After 12 months of treatment,compared with the OMT group,the PCI group had LVEF(53.81±5.13 vs 51.88±5.00,P<0.05),FS(33.02±1.48 vs 31.65±1.35,P<0.05),and LVEDD(48.42±2.93 vs 49.32±2.94,P<0.05),NT-proBNP[288.23(189.00,421.84)vs 343.00(187.25,625.00),P<0.05]improved significantly,and the differences were statistically significant.④After 12 months of treatment,the cumulative incidence of MACE in the PCI group was lower than that in the OMT group,(7.12%vs 16.92%,P<0.05),and it was statistically significant.Conclusion1.Elderly CTO patients benefit from percutaneous coronary intervention(PCI)and clinical intervention.2.On the basis of the optimal medical therapy,combined PCI therapy can better improve the cardiac function and clinical symptoms of elderly CTO patients,reduce the rehospitalization rate and the occurrence of major cardiovascular adverse events(MACE),improve the quality of livelihood and short-term prognosis of elderly CTO patients. |
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