经皮冠状动脉介入治疗在老年肌少症合并缺血性心肌病患者中的应用价值

Application value of percutaneous coronary intervention in elderly patients with sarcopenia and ischemic cardiomyopathy

  • 摘要:
    目的 探讨经皮冠状动脉介入治疗(PCI)在老年肌少症合并缺血性心肌病(ICM)患者治疗中的应用价值。
    方法 选取129例老年肌少症合并ICM患者作为研究对象,采用随机数字表法将其分为常规组64例和联合组65例,依据剔除标准筛选后,最终每组纳入55例患者。常规组接受常规药物治疗,联合组在此基础上接受PCI。比较2组入院时和出院1、3、6个月时的主观症状、血压收缩压(SBP)、舒张压(DBP)、美国纽约心脏病学会(NYHA)心功能分级、加拿大心血管病学会(CCS)心绞痛分级、左心室功能指标左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、血清学指标血清氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、6 min步行距离(6MWD), 并观察2组主要不良心血管事件(MACE)发生情况。
    结果 联合组55例患者PCI术中均植入1~3个支架,平均植入数量为(1.78±0.36)个,手术成功率为100.00%。2组出院1、3、6个月时胸痛、心悸、胸闷、乏力评分和SBP、DBP、NYHA心功能分级、CCS心绞痛分级均低于入院时,且联合组出院3、6个月时上述指标均低于常规组,差异有统计学意义(P < 0.05); 2组出院1、3、6个月时LVEDD、LVESD均小于入院时, LVEF高于入院时,血清NT-proBNP、cTnT、CK-MB水平均低于入院时,且联合组出院3、6个月时LVEDD、LVESD小于常规组,LVEF高于常规组,血清NT-proBNP、cTnT、CK-MB水平低于常规组,差异有统计学意义(P < 0.05); 2组出院1、3、6个月时6MWD均长于入院时,且联合组出院3、6个月时6MWD长于常规组,差异有统计学意义(P < 0.05); 出院6个月时,联合组MACE发生率低于常规组,差异有统计学意义(P < 0.05)。
    结论 PCI应用于老年肌少症合并ICM患者的治疗中,能够显著改善患者的主观症状和客观心功能指标,同时降低MACE发生率。

     

    Abstract:
    Objective To explore the application value of percutaneous coronary intervention (PCI) in the treatment of elderly patients with sarcopenia and ischemic cardiomyopathy (ICM).
    Methods A total of 129 elderly patients with sarcopenia and ICM were selected as study subjects and randomly divided into conventional group (64 patients) and combined group (65 patients) using a random number table method. After screening based on exclusion criteria, 55 patients were ultimately included in each group. The conventional group received conventional drug therapy, while the combined group received PCI in addition to conventional therapy. Subjective symptoms, blood pressure systolic blood pressure (SBP), diastolic blood pressure (DBP), New York Heart Association (NYHA) functional class, Canadian Cardiovascular Society (CCS) angina class, left ventricular function indicators left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), serological indicators N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), creatine kinase-MB (CK-MB), and 6-minute walk distance (6MWD) were compared between the two groups at admission and 1-, 3-, and 6-month after discharge. Additionally, the incidence of major adverse cardiovascular events (MACE) was observed in both groups.
    Results All 55 patients in the combined group underwent PCI with implantation of 1 stent to 3 stents, with an average of (1.78±0.36) stents implanted per patient, and the surgical success rate was 100.00%. At 1-, 3-, and 6-month after discharge, the scores for chest pain, palpitations, chest distress, and fatigue, as well as SBP, DBP, NYHA functional class, and CCS angina class, were lower in both groups compared to admission. Furthermore, these indicators were lower in the combined group than in the conventional group at 3 and 6 months after discharge (P < 0.05). At 1-, 3-, and 6-month after discharge, LVEDD and LVESD were smaller, LVEF was higher, and serum levels of NT-proBNP, cTnT, and CK-MB were lower in both groups compared to admission. Additionally, LVEDD, LVESD, and serum levels of NT-proBNP, cTnT, and CK-MB were lower, and LVEF values were higher in the combined group than those in the conventional group at 3 and 6 months after discharge (P < 0.05). The 6MWD was longer in both groups at 1-, 3-, and 6-month after discharge compared to admission, and the combined group was longer than that in the conventional group at 3 and 6 months after discharge (P < 0.05). At 6 months after discharge, the incidence of MACE was lower in the combined group than in the conventional group (P < 0.05).
    Conclusion The application of PCI in the treatment of elderly patients with sarcopenia and ICM can significantly improve subjective symptoms and objective cardiac function indicators, and reduce the incidence of MACE.

     

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