| BackgroundChinese population is aging and the incidence of coronary heart disease has been increased significantly,the number of aged patients with coronary heart disease is also increasing.Coronary heart disease is one of the main factors that affect the quality of life of the elderly and cause their death.Aged patients usually have more clinical complications than younger patients,such as chronic heart failure,chronic renal insufficiency,chronic lung disease and so on.The lesions of their coronary artery are usually multiple and the diffuse lesions,left main lesions,calcified lesions and chronic total occlusion lesions are more common.The above characteristics make the difficulty and risk of PCI in aged patients increased.The feasibility of PCI in aged patients with coronary heart disease is explicit,but to these patients with the multivessel disease,the outcomes related with different revascularization strategies are still not well known.PurposeTo investigate the effect of PCI on the clinical prognosis in aged patients with coronary heart disease involving multiple coronary arteries who obtained complete revascularization or incomplete revascularization after PCI and guide the doctors to make more reasonable intervention treatments for the aged patients.MethodA total of consecutive 341 aged patients(?75 years old)with confirmed coronary heart disease that involved multiple coronary arteries,who were admitted to authors' hospital during the period from January 2015 to December 2015 to receive PCI,were enrolled in this study.Based on the complete revascularization(CR)or incomplete revascularization(ICR)after PCI,the patients were divided into CR group and ICR group.There were 200 patients received CR and 141 patients received ICR.The general situation,clinical complications,results of the accessory examination,drugs,the results of coronary arteriongraphy and PCI were recorded.All patients were followed up for 2 years after PCI.The recurrent angina,rehospitalization,revascularization again and the happening of MACCE during the follow-up were recorded.The recorded data were analyzed statistically and Kaplan-Meier curves were created for survival analysis.Univariate analysis wasperformed to extract items associated with MACCE and multivariate Cox proportional hazard models were performed to adjust for baseline risk factors.Results1.Clinical baseline characteristicsThe average age of patients in group ICR was significantly higher than that in group CR(80.78±4.09 vs 79.24±3.90,P<0.05).There were no differences in the length of stay and hospitalization expenses between the two groups(P>0.05).The proportions of patients with the history of hypertension,chronic lung disease and chronic renal disease in ICR group were higher than those in CR group(85.1% vs 74.5%,P<0.05;17.0% vs 8.5%,P<0.05;14.2% vs 7.5%,P<0.01).There were no statistical differences in the risk factors such as diabetes,smoking history and hyperlipidemia between the two groups(P>0.05).The urea nitrogen and serum creatinine in ICR group were higher than those in CR group(P<0.05),glomerular filtration rate in ICR group was lower than that in CR group(P<0.05).There were no significant differences in the level of blood fat,troponin and ejection fraction between the two groups(P>0.05).The proportion of abnormal BNP in ICR group was higher than that in CR group(53.9% vs39.9%,P<0.05).Most of the patients were admitted to the hospital for acute coronary syndrome and unstable angina pectoris took the first place,243(71.3%)patients were diagnosed with it.There were no statistical differences in the diagnoses of stable angina,NSTEMI,unstable angina and STEMI between the two groups(P>0.05).2.Drug treatmentAll the patients were given cumulative load dose of aspirin and clopidogrel before the operation and long term antiplatelet therapy after PCI.337(98.5%)patients were given dual anti-platelet therapy after operation.281(83.4%)patients were treated with aspirin and clopidogrel,53(15.7%)were given aspirin and ticagrelor.All the patients were treated with lipid lowering drug,337(98.8%)were treated with enhanced statins.More than half of the patients used ACEI or ARB(51.6%)and beta-blockers(56.3%)after operation to inhibit ventricular remodeling and improve prognosis.There were no statistical differences in the use of these two drugs between the two groups(P>0.05).3.Coronary angiography and interventional therapy26(7.6%)patients got emergency PCI and others got elective PCI.There was no difference in the proportion of emergency PCI between CR and ICR group(P>0.05).The duration of PCI in ICR group is longer than that in CR group(75.57±43.21 min vs65.50±29.28 min,P<0.05).According to coronary angiography,the complexity of the lesions in ICR group was significantly higher than CR group.The proportions of 3-branch-lesion,left main coronary artery disease and type C lesion in ICR group were higher than those in CR group(74.5%vs 36.0%,18.4% vs 7.0%,75.9% vs 34.0%,P < 0.01).The proportions of occluded,calcified and ostial lesions in ICR group were higher than those in CR group(51.8% vs16.5%,23.4% vs 11.0%,47.5% vs 31.5%,P<0.01),the Syntax I score in ICR group was also significantly higher than that in CR group(27.64±12.28 vs 16.19±8.15,P<0.01).15(4.4%)patients got PTCA,the proportion of PTCA in group ICR was higher than that of group CR(9.4% vs 1.0%,P< 0.01).325(95.3%)patients were implanted with stents successfully.There were no differences in the average numbers,the total length and diameter of the stents between the two groups(P>0.05).But the propotion of receiving more than 3 stents in ICR group was higher than that in CR group(57.4% vs 29.5%,P<0.01).4.Prognostic analysisThere are still some patients who had recurrent angina after PCI and the number of patients with discomfort reached the peak at 1 year after PCI.36.5% of patients felt uncomfortable,34.1% in CR group and 40.0% in ICR group.There was no significant difference in the proportion of patients who had recurrent angina after PCI during the follow-up between CR group and ICR group(P>0.05).The ratios of rehospitalization and revascularization again in group CR were lower than those in group ICR during the 2 years after PCI(29.0% vs 39.7%,10.5% vs 22.0%,P<0.05).Followed up to 24 months after PCI,MACCE events occurred in 80 patients.The cumulative incidence of MACCE events in the CR group was lower than ICR group during the follow-up period(20.0% vs 30.1%,P < 0.05).Interventional strategies for revascularization was an independent predictor of the occurrence of MACCE events at 12 months after PCI(OR=1.922,95% CI=1.038-3.560,P<0.05),but was not an independent predictor of MACCE events at 24 months after PCI(P>0.05).There were 49(14.4%)patients died during 2 years after PCI,25(7.8%)were associated with heart.During 24 months after PCI,the mortality of patients in ICR groupwas significantly higher than that in CR group(21.3% vs 10.8%,P<0.01).In terms of cardiovascular mortality,there was no significant difference between the two groups(P>0.05).Interventional strategies for revascularization was an independent predictor of the occurrence of all causes of death at 24 months after PCI(OR=2.066,95% CI=1.026-4.393,P<0.05).Conclusion1.The aged patients with coronary heart disease generally had more clinical complications;most of them were diagnosed with acute coronary syndrome and had more complex lesions.The average age,the histories of hypertension and chronic renal disease,and the complexity of the lesions in ICR group were significantly higher than those in CR group.2.There were no differences in the length of stay and hospitalization expenses between the two groups during this study,but the ratios of rehospitalization and revascularization again in group ICR were higher than those in group CR.The economic burden was increased.3.The aged patients with chronic complex lesions tended to choose incomplete revascularization.Complete revascularization appeared to suppress middle and long term ischemic events,improve the survival rate.4.The revascularization strategies should be based on the characteristics of the clinic and vascular stenosis.Complete revascularization is suggested to improve the quality of life and clinical prognosis if possible.Individualized therapy is better for the high-risk patients with multivessel disease. |
PDF Full Text Request