| Backgroud and Objective: With the acceleration of the aging population,the proportion of elderly patients with acute ST segment elevation myocardial infarction(STEMI)is more and more large.2012 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation pointed out: direct percutaneous coronary intervention(PCI)is the most effective method of treatment of acute STEMI,early,continuous and effective opening of infarct related artery,effective recovery of myocardial perfusion.In recent years,a large number of studies have showed that: compared with the femoral artery path PCI,the radial artery path can significantly reduce the risk of bleeding and improve the survival rate.Compared with young patients,the elderly STEMI patients in the clinical features and coronary lesion characteristics are different,Elderly patients often have vascular variation,high incidence of tortuosity of radial artery and truncus brachioce phalicus artery.Therefore,it is necessary to study for elderly patients with STEMI the effect of PCI by radial approach,postoperative complications and adverse cardiac events.The purpose of this study was to observe the clinical and coronary angiographic characteristics of elderly patients with acute STEMI,evaluate the feasibility and safety of transradial artery PCI.Methods: This study is a single center clinical observation.Patients with STEMI who had received coronary artery intervention treatment from January 2011 to April 2015 in our hospital were selected,and according to the age they were divided into elderly group(age?65 years old,n=105)and the control group(age< 65 years old,n=102).According to the age of the patients were divided into elderly group: 65 years of age or older.The average age was 73.9 ±4.9 years,a total of 105 cases,including 74 cases of male,female 31 cases;control group: age less than 65 years.The average age of 52.8± 6.5 years,a total of 102 cases,including 87 cases of male,female 15 cases.Interventional procedure:Preoperative oral aspirin 300 mg and clopidogrel 300mg(If clopidogrel is not taken before operation,clopidogrel is 600mg),atorvastatin 80 mg orally.Allen'S test negative,Transradial coronary angiography and percutaneous coronary intervention.To observe two groups risk factors,characteristics of clinical,coronary lesions,the effect of PCI,postoperative complications and adverse cardiac events.Results: 1.Clinical characteristic: Compared with younger patients,the incidence of male in the elderly was lower.The incidence of family history of coronary heart disease and smoking in the elderly group were significantly lower than those in the control group(P<0.05),there were no significant differences between the two groups in the patients with hypertension,diabetes,hyperlipidemia(P>0.05).Compared with control group,the ratio of typical chest pain was lower,the ratio of explicit incentive was higher,onset to admission time was longer,temporary pacemaker and cardioerter ratio was higher in the elderly group(P<0.05).2.The characteristics of coronary lesions and procedural performances: Compared with control group,multivessel lesion and balloon dilatation ratio was higher,the proportion of single lesion,thrombus suction,and using GPI IIb/IIIa receptors inhibitors was lower in elderly group(P<0.05).In the two groups,there was no significant difference in the distribution of blood vessels,the proportion of stent placement and the number(P> 0.05).3.Interventional effect: Success rate of radial artery puncture and operation,operation time was no significant difference between two groups(P>0.05).Although door to balloon time in the elderly group was longer(P<0.05),but the proportion of the door to balloon time<90min had no difference(P>0.05).There was no significant difference between the two groups in radiation dose,X-ray time and the dosage of contrast agent(P>0.05).4.Complications and adverse cardiac events: there was no significant difference on bleeding,cardiac shock and stent thrombosis intwo groups(P>0.05).Although the cardiac function was worse and EF value of postoperative 24 hours was lower in the elderly group(P<0.05),but the in-hospital mortality rate of two groups had no significant difference.Conclusion: 1.Compared with younger patients,in elderly patients with acute STEMI,the incidence rate of male patients is lower,usually have a clear incentive,the lack of typical chest pain symptoms,the need for temporary pacemaker and cardioerter is more.2.In elderly patients with acute STEMI,multivessel lesion was more;vascular stenosis of serious and intraoperative requires balloon expansion;the need for thrombus suction and using GP IIb/IIIa receptors inhibitors was lower.3.In elderly patients with acute STEMI,although door to balloon time was longer,but most of the patients were completed reperfusion therapy within 90 min to achieve the requirements ofthe guidelines.4.Elderly patients with acute STEMI transradial PCI postoperation,that bleeding,stroke,stent thrombosis and other complications are lower,have the same safe and effective from the young patients,can be considered as the first choice of elderly emergency PCI operation approach,has good clinical application value. |
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