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目的:对比评价药物洗脱支架和金属裸支架对75岁以上高龄患者的安全性和有效性。方法:2005-11至2006-12我院75岁以上接受冠状动脉支架置入术的患者269例,年龄在75～87岁;其中,药物洗脱支架组140例,金属裸支架组129例。30天、6～12个月进行临床随访,对比2组全因死亡和主要不良心脏事件(MACE,包括心脏性死亡,非致死性心肌梗死和靶病变血运重建的发生率)。结果:药物洗脱支架组支架直径显著小于金属裸支架组(P<0.05),支架长度显著大于金属裸支架组(P<0.05)。30天 MACE 药物洗脱支架组与金属裸支架组差异无统计学意义(P>0.05)。术后6～12月随访,两组只有靶病变血运重建率在药物洗脱支架组显著低于金属裸支架组(P<0.001),在总随访率、造影复查率、造影复查时间、MACE 和全因死亡率等之间均无显著差异(P 均>0.05)。药物洗脱支架组晚期血栓发生率为1.4%,金属裸支架组未见晚期血栓发生。结论:药物洗脱支架和金属裸支架对75岁以上的高龄患者具有同样的疗效和安全性,并且 MACE 有减少的趋势,但药物洗脱支架有发生晚期血栓的可能性。
OBJECTIVE: To evaluate the safety and efficacy of drug-eluting stents and bare-metal stents in elderly over 75 years old. Methods: From November 2005 to December 2006, 269 patients aged 75 to 87 years old undergoing coronary stent implantation were enrolled in this study. Their ages ranged from 75 to 87 years. Among them, there were 140 cases of drug-eluting stents and 129 cases of bare metal stents. The clinical follow-up was performed at 30 days and 6-12 months. The incidence of all-cause and major adverse cardiac events (MACE, including cardiac death, non-fatal myocardial infarction, and target revascularization) was compared between the two groups. Results: The stent diameter of the drug-eluting stent group was significantly smaller than that of the bare metal stent group (P <0.05), and the stent length was significantly larger than that of the bare metal stent group (P <0.05). There was no significant difference between the 30-day MACE drug-eluting stent group and the bare metal stent group (P> 0.05). After 6-12 months of follow-up, only the target lesion revascularization rate was significantly lower in the drug-eluting stent group than in the bare metal stent group (P <0.001). The overall follow-up rate, angiographic review rate, And all-cause mortality were not significantly different (P all> 0.05). The incidence of late thrombosis was 1.4% in the drug-eluting stent group, and no advanced thrombosis occurred in the bare metal stent group. Conclusions: Both drug-eluting stents and bare-metal stents have the same efficacy and safety for elderly patients over the age of 75 with a decreasing trend in MACE, but drug-eluting stents have the potential for late thrombosis.