高齢者（75歳以上）急性心筋梗塞患者に対するdirect PTCA施行例の検討

Clinical Evaluation of Direct Percutaneous Transluminal Coronary Angioplasty in Elderly Patients (over 74 years old) with Acute Myocardial Infarction

　75歳以上の高齢者急性心筋梗塞（AMI）患者に対するdirect PTCA（d-PTCA）療法の有用性を75歳未満の非高齢者AMI患者と比較検討した．AMIの初期治療としてd-PTCAを行った75歳以上の高齢者15例（A群）と75歳未満の非高齢者15例（B群）の計30例を対象とし，初期成功率，梗塞責任病変の狭窄度，死亡率，心事故発生率，心筋逸脱酵素，左心機能，合併症などを比較し，以下の結果を得た．①初期成功率（A群93％　vs B群100％），残存狭窄度（d-PTCA後31±20％　vs 29±9％，再CAG 48±36％ vs 39±25％），②死亡率（A群13％　vs B群7％），梗塞後狭心症（20％　vs 27％），再梗塞（13％　vs 13％），再狭窄（25％　vs 15％），③心筋逸脱酵素，左心機能は有意差なし．④合併症（A群6例 vsB群3例）．以上d-PTCAは合併症の発生に注意すれば75歳以上の高齢者に対しても非高齢者と同様にAMIの初期治療として有用であった．

We investigated the usefulness of direct percutaneous transluminal angioplasty (PTCA) in 15 elderly patients with acute myocardial infarction (AMI) who were 75 years old or older (Group A), compared with 15 AMI patients less than 75 years old (Group B). We examined the initial success rate. residual stenosis of infarct-related vessels, mortality, incidence of cardiac events, cardiac enzyme release, left ventricular function, and complications after direct PTCA in both groups. The results were as follows. ① the initial success rate (Group A vs Group B; 93% vs 100%), residual stenosis (Group A vs Group B; 31±20% vs 29±9% after direct PTCA, 48±36% vs 39±25% at the time of follow-up angiogra-phhy) ② mortality (Group A vs Group B; 13% vs 7%), post infarctional angina (Group A vs Group B; 20% vs 27%), reinfarction (Group A vs Group B; 13% vs 13%). restenosis (Group A vs Group B; 25% vs 15%) ③ There were no significant differences between these two groups in cardiac enzyme release or left ventricular function. ④ complications (Group A vs Group B; 6 cases vs 3 cases). We conclude that direct PTCA was useful in elderly AMI patients aged 75 years old or older as well as in AMI patients less than 75 years old.