血管内成像使用率高的中心对年龄小于 75 岁和大于 75 岁的老年人进行慢性全闭塞经皮冠状动脉介入治疗的可行性、安全性和中期临床效果研究

Heng Shee Kim, Shinji Imura, Motosu Ando, M. Tsukiji, Yasuhiro Tarutani, Yuuki Nakanishi, F. Hosaka
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摘要

背景:慢性全闭塞(CTO)在老年患者中很常见,但有关他们接受 CTO 经皮冠状动脉介入治疗(PCI)效果的数据仍然有限。了解 CTO 经皮冠状动脉介入治疗在这一人群中的可行性、安全性和临床疗效对优化治疗至关重要。本研究旨在评估年龄小于 75 岁和大于 75 岁的老年患者在这些方面的情况。研究方法在日本一家中心接受 CTO-PCI 的 258 名患者分为两组:年龄<75岁和≥75岁。收集了人口统计学、临床因素、血管造影和手术数据。随访数据来自电子健康记录。主要结果指标是随访一年时的靶病变失败(TLF)。通过 Kaplan-Meier 曲线分析和多变量 Cox 回归分析来确定 TLF 的预测因素。结果显示68.6%的患者年龄小于75岁,31.4%的患者年龄≥75岁。手术成功率相似。1年TLF、死亡、非致死性心肌梗死或靶病变血运重建方面无明显差异。老年组的术中并发症发生率较高。机械循环支持和急诊 PCI 对老年患者的无靶器官血运重建存活率有负面影响,而高血压似乎具有保护作用。结论:本研究证明了 CTO-PCI 在老年患者中的可行性、安全性和良好的中期疗效。这些研究结果表明,CTO-PCI 有可能成为适合老年患者的治疗选择。此外,研究还发现了不良事件的可能风险因素,为未来的管理策略提供了潜在指导。因此,CTO 老年患者在适当的时候不应被剥夺有创 PCI 策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Feasibility, Safety and Middle Term Clinical Outcome Study of Chronic Total Occlusion Percutaneous Coronary Intervention among Elderly Aged <75 Years versus ≥75 Years in a High Intravascular Imaging Usage Centre
Background: Chronic total occlusion (CTO) is common among elderly patients, yet data on their outcomes with CTO percutaneous coronary intervention (PCI) remain limited. Understanding the feasibility, safety and clinical outcomes of CTO-PCI in this population is crucial for optimal care. The present study aimed to evaluate these aspects in elderly patients aged <75 versus ≥75 years. Methods: Two hundred and fifty-eight patients who underwent CTO-PCI at a single Japanese centre, categorised into two groups: <75 and ≥75 years old, were retrospectively analysed. Demographics, clinical factors, angiography and procedure data were collected. Follow-up data were obtained from electronic health records. The primary outcome measure was target lesion failure (TLF) at 1-year follow-up. Kaplan-Meier curve analysis and multivariable Cox-regression analysis were performed to identify predictors of TLF. Results: 68.6% were <75 years old and 31.4% were ≥75 years old. Similar procedural success rates were observed. There were no significant differences in 1-year TLF, death, non-fatal MI or target-lesion revascularisation. The older group had a higher rate of intraprocedural complications. Mechanical circulatory support and emergency PCI negatively impacted target-lesion revascularisation-free survival in older patients, while hypertension appeared protective. Conclusion: The present study demonstrates the feasibility, safety and good mid-term outcomes of CTO-PCI in elderly patients. These findings suggest its potential as a treatment option for appropriate elderly patients. Additionally, possible risk factors for adverse events were identified, potentially guiding future management strategies. Therefore, elderly patients with CTO should not be deprived of invasive PCI strategies when appropriate.
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