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目的:探讨老老年急性冠状动脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）后，影响短期预后的相关因素及特点。方法:选择2010年1月1日至2014年10月31日在中国医科大学附属盛京医院住院并行PCI的ACS患者2 912例，根据年龄将患者分为老老年组（≥ 75岁，480例）和对照组（<75岁，2 432例），比较两组患者临床资料及冠状动脉病变情况，随访并记录所有患者出院后30 d内主要心血管不良事件（MACE）的发生情况。应用多因素Logistic回归分析老老年ACS患者发生MACE的危险因素。结果:与对照组比较，老老年组高血压病史比例、全球急性冠状动脉事件注册评分、高密度脂蛋白胆固醇（HDL-C）水平、N末端脑钠肽前体（NT-proBNP）水平、左主干病变率、Gensini评分均高于对照组，而男性比例、吸烟史比例、高脂血症比例、红细胞计数、白细胞计数、血小板计数、白蛋白（ALB）水平和出院后可坚持口服阿司匹林、氯吡格雷、他汀类药物及血管紧张素受体拮抗剂（ARB）比例均低于对照组，差异有统计学意义（n P<0.01或<0.05）。随访期间老老年组全因死亡率高于对照组[2.5%（12/480）比0.9%（21/2 432）]，差异有统计学意义（n P<0.01）。多因素分析显示对于老老年ACS患者出院后口服血管紧张素转化酶抑制剂（ACEI）是保护因素（n OR = 0.046，95% n CI 0.006~0.383，n P = 0.004）；应用受试者工作特征曲线评定Gensini评分对全因死亡的预测阈值为87.75分，曲线下面积0.709，n P = 0.01，95% n CI 0.729~0.891；高Gensini评分（≥ 87.75分）组发生全因死亡率明显高于低Gensini评分（<87.75分）组[6.6%（9/137）比0.9%（3/343）]，差异有统计学意义（n P<0.01）。n 结论:老老年ACS患者无论从临床病史还是预后相关因素均有其自身特性，对于Gensini评分≥ 87.75分的患者应密切观察，必要时强化住院期间药物治疗，并加强随访，尤其注意出院后坚持继续口服药物治疗。“,”Objective:To investigate the characteristics of short-term prognostic factors in very elderly patients with acute coronary syndrome (ACS).Methods:A total of 2 912 ACS patients admitted to Shengjing Hospital of China Medical University from January 1, 2010 to October 31, 2014 and treated with percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to age: very elderly group (≥75 years, 480 cases) and control group (< 75 years, 2 432 cases). The clinical data and coronary artery lesions of the included patients were detected. Major cardiovascular adverse events (MACE) occurred within 30 d after discharge were followed up and recorded. The short-term prognostic factors in very elderly patients with ACS were analyzed by Logistic regression.Results:Compared with control group, the percentage of hypertension, global registry of acute coronary events (GRACE) score, high density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, the left main lesion ratio and Gensini score in very elderly group were higher, while the percentage of men, number of smoking, hyperlipidemia proportion, red blood cell count, white blood cell count, blood platelet count, albumin, and long term oral administration of aspirin, clopidogrel, statins, angiotensin receptor inhibitor after discharge were lower, and the differences were statistically significant (n P<0.01 or<0.05). During the follow-up period, the all-cause mortality in very elderly group was higher than that in control group: 2.5%(12/480) vs. 0.9% (21/2 432), and the difference was statistically significant (n P<0.01). Multivariate analysis showed that oral angiotensin converting enzyme inhibitor was a protective factor for elderly ACS patients after discharge (n OR = 0.046, 95% n CI 0.006 to 0.383, n P = 0.004). The receiver operating characteristic curve analysis showed that Gensini score ≥ 87.75 scores was a threshold value for all-cause mortality. The all-cause mortality ratio in high Gensini score (≥ 87.75 scores) group was higher than that in low Gensini score (<87.75 scores) group: 6.6% (9/137) vs. 0.9% (3/343), and the difference was statistically significant (n P<0.01).n Conclusions:Very elderly patients with ACS have their own characteristics from both clinical history and prognostic factors. Patients with Gensini score of ≥ 87.75 scores should be closely observed, and drug treatment during hospitalization should be intensified if necessary. Follow-up should be strengthened for such patients, and oral drug treatment should be continued after discharge.