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目的:评价80岁以上老年患者经桡动脉途径行经皮冠状动脉介入治疗(PCI)的安全性和临床疗效。方法:2003-05至2007-05进行PCI 80岁以上的高龄患者268例,男性176例,年龄80～97岁;经股动脉途径PCI组156例(股动脉组),经桡动脉途径PCI组112例(桡动脉组)。对比两组的临床特点、PCI特点、住院期间主要的不良心脏事件(MACE,包括心脏性死亡、非致死性心肌梗死和靶病变再次重建率)。结果:桡动脉组与股动脉组相比,PCI的成功率相似,均在95%以上;桡动脉组需要更改途径的比率显著增高(P<0.05);冠状动脉导管插入时间(P<0.01)、X线曝光时间(P<0.05)均显著延长;造影剂用量有增多趋势(P>0.05),但两组差异未达统计学意义;术后卧床时间显著缩短(P<0.01),所有原因的穿刺部位血管并发症显著降低(P<0.01),其中,局部出血发生率(P<0.01)和局部血肿发生率(P<0.01)均显著减低。经多因素回归分析显示,桡动脉途径(OR=0.25,CI=0.09～0.75)是穿刺部位血管并发症独立的阴性预测因素。结论:80岁以上高龄患者的PCI,桡动脉途径可以降低穿刺血管局部并发症,与股动脉途径相比具有同样的临床效果和成功率,但是,穿刺失败率高,穿刺时间和曝光时间较长。
Objective: To evaluate the safety and clinical efficacy of percutaneous coronary intervention (PCI) via the radial artery in elderly patients over 80 years of age. Methods: Between May 2003 and May 2007, 268 elderly patients aged 80 years and over were enrolled. Among them, 176 were male and were aged from 80 to 97 years. PCI was performed in 156 patients (femoral artery group) via femoral artery PCI group, 112 cases (radial artery group). The clinical characteristics, PCI characteristics, major adverse cardiac events during hospitalization (MACE, including cardiac death, non-fatal myocardial infarction, and target lesion re-reconstruction rates) were compared between the two groups. Results: The success rates of PCI in the radial artery group and the femoral artery group were similar, all above 95%. The radial artery group needed to change the route significantly higher (P <0.05), coronary catheterization time (P <0.01) , X-ray exposure time (P <0.05) were significantly prolonged; the amount of contrast agent increased trend (P> 0.05), but the difference between the two groups was not statistically significant; postoperative bed time was significantly shorter (P <0.01) (P <0.01). The incidence of local hemorrhage (P <0.01) and the incidence of local hematoma (P <0.01) were significantly decreased. The multivariate regression analysis showed that the radial artery approach (OR = 0.25, CI = 0.09 ~ 0.75) was an independent negative predictive factor for vascular complications at the puncture site. CONCLUSION: The PCI and radial artery approach of elderly patients over 80 years can reduce the local complications of puncturing blood vessels, which has the same clinical effect and success rate as the femoral artery approach. However, the puncture failure rate is high, the puncture time and exposure time are longer .