| Coronary heart disease(CHD),the most common type of organ damage due to atherosclerosis, is seriously harmful to people’s health.CHD often occurs after midlife, more in male than female. Age is one of important risk factors for CHD. The research of Framingham risk score shows that the absolute risk of CHD increases along with the growth of the age. On the basis of2006data from WHO, about7,200,000people died of CHD every year. Each year, an estimated more than780,000Americans will have a new coronary attack.CHD mortality in2007was more than400,000. With the development of living standards and the change of lifestyle, the incidence and the mortality rates of CHD in China increases yearly. The recent statistical data showed that the CHD incidence rates were120per100,000. and the average mortality rates were90.1per100.000for males and53.9per100,000for females.It’s confirmed by large amount of epidemiological statistical data that hypertension(HT), dyslipidemia, smoking, obesity and diabetes mellitus(DM) were the major risk factors for CHD, dyslipidemia especially with the most research evidence. Lipid metabolism abnormity, which displays as high level of TC,TG and LDL-C, low level of HDL-C, plays a dominant role in the development of atherosclerosis. The lipid-lowering treatment decreases CHD morbidity effectively, which previously focused on lowering the level of TC,TG and LDL-C, but some patients still experienced a new or recurrent cardiovascular disease attack, even if the lipid-lowering treatment goals had been achieved. Therefore, it’s not enough to assess the risk of CHD only with the blood lipid indicators mentioned-above. In recent years, new blood lipid indicators and the correlation with CHD has become a new hotspot of study. Like, it was suggested that nonHDL-C as the secondary target of lipid-lowering treatment by The National Cholesterol Education Program Adult Treatment Panel III. The findings of large-scale prospective study performed on the relationship between nonHDL-C and the risk of CHD attack revealed that nonHDL-C predicted CHD events slightly better than LDL-C. It has been analyzed by Bogalusa heart study that the utility of nonHDL-C in the identification of subclinical atherosclerosis in young adults. But the data of correlations between coronary atherosclerosis and blood lipid indicators mentioned-above in very elderly patients is less.As one of the type of CHD and based on coronary atherosclerosis, Acute myocardial infarction (AMI) make myocardial ischemic seriously and necrotic due to the blood flow of coronary artery drop sharply or interrupted suddenly. AMI is one of the most common cardiovascular emergencies, and nearly1/3of AMI patients were>/=75years of age. Aging is positively correlated with AMI mortality rates in elderly, thus the average mortality rates are1.6%up with every1year older. The in-hospital mortality rates of AMI among patients aged75years and over has been reported to be up to4times higher than that for patients aged less than65years. AMI is the leading cause of common death in elderly.It is well known that the earlier restoration of coronary antegrade flow, the smaller area myocardial necrosis in AMI patients. Thrombolysis therapy and percutaneous coronary intervention(PCI) recover myocardial reperfusion rapidly for ST-segment elevation myocardial infarction(STEMI) patients. Several large randomized trials have confirmed the efficiency of thrombolytic therapy in reducing short-and long-term mortality from AMI. The ISIS-2trial first demonstrated this benefit for those over the age of70years. However, an overview of mortality at5weeks in the9largest trials by the FTTC Group did not confirm a survival advantage for thrombolysis in patients over the age of75years. The clinical application of thrombolytic therapy is obviously limited in elderly STEMI patients. It is obvious that the proportion of patients with contraindications of thrombolytic therapy (especially with previous stroke and gastrointestinal bleeding) in elderly is higher than that in the non-elderly, and the risk of bleeding from thrombolytic agents rise with increasing age. Furthermore, rethrombosis occurring within hours of successful lysis of a coronary thrombus has emerged as a major problem limiting the clinical benefit of thrombolytic therapy in AMI. AMI usually is triggered by plaque rupture, which exposes thrombogenic elements of the vessel wall such as collagen, and these agonists are reexposed when the occlusive thrombusis lysed. Residual thrombus, which commonly remains after current thrombolytic treatment, is a particularly potent stimulus to rethrombosis. A residual stenosis of>75%increases the likelihood of reocclusions. It has been reported that about half of the early reocclusions occur within the first24hours.and about5%-20%of patients with heart attacks who undergo successful thrombolysis reocclude in the ensuing12-24hours. PCI can effectively improve ischemic symptoms and prognosis, and reduce the short-term mortality in the elderly patients with CHD. Over the past nearly20years, with the improvement of surgical instruments and increasing surgeon experience, from the balloon dilation in angioplasty, to the clinical application of bare metal stents and drug-eluting stents, the success rate of PCI and the proportion of patients over65years old has increased significantly yearly.But patients>/=80years old with CHD constitute a particular risk group in relation to PCI. The very elderly patients(>/=80years old), whose culprit coronary lesions usually involve multi-major blood vessels and the proportion of complex lesion as seriously calcified, left main stenosed and totally occluded significantly increase, have many kinds of comorbidities such as HT, DM, chronic kidney disease(CKD) and cerebrovascular disease, and are more likely to have complications in the process of PCI therapy. It’s essential to undergo PCI treatment prudently in the very elderly patients.The experiment is divided into two parts. First, to examine the level of blood lipid indicators (TC,TQHDL-C,LDL-C,AIP,LDL/HDL,nHDL-C) and analyse the relationship with distribution and extent of culprit lesion in coronary artery in CHD patients, to assess the correlations between lipid metabolism with coronary atherosclerosis and effective predictors of exent of coronary atherosclerosis and risk of CHD in very elderly patients with CHD. Second, to evaluate the efficiency and recent safety of primary and elective PCI in the very elderly patients with AMI.Objective:To find correlations between lipid metabolism and coronary atherosclerosis and effective predictors of exent of coronary atherosclerosis and risk of CHD in very elderly patients with CHD.Method:A retrospective analysis was performed in162elderly patients (≥80years of age) who underwent coronary angiography(CAG) in our hospital and never had received lipid-lowering treatment before. The levels of serum glucose(fasting blood glucose) and serum lipid indicators (TC, TG, HDL-C, LDL-C) were measured by autoanalyzer. The value of AIP, LDL/HDL, nHDL-C were calculated. Record the result of CAG, including the stenosed position and extent of culprit lesion in coronary artery. The severity of coronary artery lesion was evaluated by Gensini scores. With non-CHD subjects as control group, patients in CHD with coronary lesions (diameter≥2mm,stenosis>50%) were divided into single-vessel group, double-vessels group and multi-vessels group, and the stenosed extent of culprit lesion was classified as51%-89%,90%-99%,100%, which was defined as mild, moderate and severe, respectively. All cases were divided into different groups with whether patients had CHD or not, distribution and extent of culprit lesion in coronary artery. The difference among groups were compared respectively. The correlations between serum lipid indicators and distribution and extent of culprit lesion and Gensini scores was analyzed in CHD group.Result:The ratio of serum lipid abnormity in all subjects was63%. The prevalences of hypercholesterolemia, hypertriglyceridemia and low HDL-C were29.6%,18.5%, and30.2%, respectively. The mean levels of TC, nHDL-C were higher in female than in male in CHD and non-CHD group,respectivesly. The distribution and extent of culprit lesion in coronary artery were positively associated with LDL/HDL, AIP, and negatively associated with HDL-C in very elderly patients with CHD. Conclusions:In very elderly patients with CHD, elevated HDL-C has a protective effect on the progression of CHD, and AIP and LDL/HDL ratio are reliable indicators of exent of coronary atherosclerosis and risk of CHD.Objective:We aimed to evaluate the efficiency and recent safety of primary and elective percutaneous coronary intervention (PCI) in the very elderly patients (>/=80years old) with Acute myocardial infarction(AMI).Methods:120very elderly patients with coronary heart disease (CHD) were enrolled and divided into AMI group(36STEMI cases and19NSTEMI cases) and non-AMI group (control group of65cases).18AMI patients (the onset of the disease within12hours) underwent primary PCI (P-PCI) at admission, while the others and non-AMI patients received elective PCI(E-PCI). The baseline clinical characteristics, angiographic features(Gensini scores, bifurcate and ostial lesion), PCI process (the procedure success rate, duration of operation, complete revascularization), PCI complication(no reflow, major bleeding event), in-hospital mortality and major adverse cardiac events(MACE) of patients in all groups were compared retrospectively.Results:The procedure success rate with TIMI-3flow grade of post-PCI in P-PCI group was lower than in E-PCI group (P=0.036). The main PCI complication is no-reflow(TIMI≤2) occured in the procedure of PCI. The P-PCI significantly enhanced the occurrence of the procedure related complications in whole-group and AMI-group patients (P<0.001, P=0.039). The occurrence of PCI complications, MACE in AMI group were significantly more than in control group(P<0.001, P=0.037). The difference was not significant as to in-hospital mortality and incidence of MACE in both P-PCI and E-PCI settings for AMI patients.Conclusions:Although primary PCI in very elderly AMI patients had a higher risk of complications compared with elective procedure, the success rate in both of them was still high and did not prolong hospitalization and increase in-hospital mortality. The procedure of primary PCI in very elderly AMI patients is safe, encouraging its wider application. |
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