在老年人冠状动脉复血管化后的生存率
Michelle M Graham1, William A Ghali, Peter D Faris
1Department of Medicine, University of Alberta, Canada.
Circulation
|May 22, 2002
概括
患有缺血性心脏病的老年患者从冠状动脉旁路移植 (CABG) 和穿皮冠状动脉干预 (PCI) 等重血管化疗法中获得的益处比以前想象的要多. 这些积极的治疗方法在老年人中显示出比单独使用药物治疗更大的绝对风险降低.
科学领域:
- 心脏病学 心脏病学
- 老年医学 老年医学
- 临床结果研究研究
背景情况:
- 患有缺血性心脏病 (IHD) 的老年患者越来越多地成为重新血管化的候选人.
- 对于接受冠状动脉旁路移植 (CABG) 或皮肤冠状动脉干预 (PCI) 的老年人未达到最佳结果存在担忧.
- 这项研究调查了不同老年年龄组不同治疗策略的生存率.
研究的目的:
- 根据他们的处方治疗,比较患有缺血性心脏病的老年患者的生存结果.
- 分析冠状动脉旁路移植 (CABG),皮肤冠状动脉干预 (PCI) 和跨年龄层的医疗治疗的生存率.
- 为了确定复血管化是否在老年患者群体中提供更大的好处.
主要方法:
- 利用了来自阿尔伯塔省冠心病结果评估项目 (APPROACH) 倡议的数据.
- 将6000多名患有内脏病的老年患者的特征和长期结果与年轻人队伍进行比较.
- 在70岁以下,70-79岁以下和80岁以上的患者中,分析了CABG,PCI和医疗治疗的4年修正精算生存率.
主要成果:
- 在≥80岁的患者中,4年生存率为CABG的77.4%,PCI的71.6%,医疗治疗的60.3%.
- 与年龄≥80岁的患者相比,CABG (17.0%) 和PCI (11.3%) 的绝对风险降低较大,与年轻患者相比,与药物治疗相比.
- 所有治疗方法的存活率通常随着年龄的增加而下降,但重血管化的好处与医学治疗相比,在老年人群中更为明显.
结论:
- 老年患者,特别是80岁以上的老年患者,与年轻人相比,在逆境中经历了更大的绝对风险降低从重血管化 (CABG/PCI).
- 研究结果表明,积极的再血管化策略可能对患有缺血性心脏病的老年患者的特定亚组具有高度益处.
- 这些结果与先前的试验相结合,支持考虑对老年患者群体进行再血管化.
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