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目的:对比评价年龄≥80岁 (老老年)和<80岁 (中老年)因ST段抬高型心肌梗死(STEMI)而直接经皮冠状动脉(冠脉)介入治疗(PPCI)并需主动脉内球囊反搏(IABP)辅助支持患者的预后.方法:回顾分析我院2004-01至2015-12因STMEI而行PPCI,并需IABP支持患者的临床、冠脉造影和随访资料.排除标准为术前合并心原性休克、机械并发症和非ST段抬高急性冠脉综合症的患者.将患者分为老老年组(≥80岁, n=51)和中老年组(<80岁,n=237).研究的主要终点包括PPCI术后1个月、1年及2年的死亡和术后1个月的主要不良心脑血管事件(MACCE,包括由死亡、心原性休克、新的或加重的心力衰竭、再次心肌梗死和卒中等组成的复合事件).使用Cox比例风险模型分析致各终点事件的独立预测因子.结果:老老年组比中老年组术后1个月的MACCE发生率显著增加(41.2% vs 24.5%,P=0.029),其中卒中事件的发生率显著增加(9.8% vs 0.8%,P0.05),但至术后2年时死亡率显著增高(35.3% vs 20.7%,Log-rank P=0.037).术后心肌梗死溶栓治疗临床试验(TIMI)血流<3级是MACCE的强独立预测因子(HR=3.41, 95%CI: 2.09~5.56, P<0.001),均是各时间点死亡的最强独立预测因子(1个月:HR=9.51,95%CI:5.23~17.29;1年:HR=7.24,95%CI:4.13~12.69;2年: HR=5.85, 95%CI:3.45~9.94;P均<0.001).年龄≥80岁对各终点事件均无显著的预测效应.结论:老老年患者术后2年死亡率显著增高;术后1个月MACCE显著增高,主要为卒中事件显著增加.年龄≥80岁对各终点事件均无显著的预测效应.“,”Objective: To compare the prognosis of intra-aortic balloon pump (IABP) supported primary percutaneous coronary intervention (PPCI) between very elderly (age ≥ 80 years) and elderly (age < 80 years) patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 288 STEMI patients received IABP supported PPCI in our hospital from 2004-01 to 2015-12 were retrospectively studied. Clinical condition, coronary angiography and follow-up data were analyzed; the patients with pre-operative cardiac shock, mechanical complication and non ST-segment elevation acute coronary syndrome were excluded. Eligible patients were divided into 2 groups: Very elderly group, n=51 and Elderly group, n=237. Major adverse cardiac and cerebral events (MACCE) as death, cardiac shock, new or worsen heart failure, re-MI and stroke were studied at 1 month and 1, 2 years after PPCI. Independent predictors for MACCE occurrence were investigated by Cox proportional hazard model analysis.Results: Compared with Elderly group, Very elderly group had increased incidence of MACCE at 1 month after PPCI (41.2% vs 24.5%), P=0.029 and obviously elevated incidence of stroke (9.8% vs 0.8%), P0.05; mortality was higher in Very elderly group at 2 years after PPCI (35.3% vs 20.7%), Log-rank P=0.037. Cox proportional hazard model analysis indicated that post-operative TIMI flow < 3 was the strong independent predictor for MACCE occurrence (HR=3.41, 95% CI 2.09-5.56, P<0.001), which was also the strongest predictor for death at different time points as at 1 month after PPCI (HR=9.51, 95% CI 5.23-17.29), at 1 year after PPCI (HR=7.24, 95% CI 4.13-12.69) and at 2 years after PPCI (HR=5.85, 95% CI 3.45-9.94), all P<0.001. Patients ≥ 80 years had no obvious predictors for end point event occurrence. Conclusion: Very elderly STEMI patients had the higher mortality at 2 years after IABP supported PPCI and increased incidence of MACCE at 1 month after PPCI. Patients≥80 years had no obvious predictors for end point event occurrence.