Kardiyak yetmezliği olan ileri yaş hastalarda en iyi tedavi yaklaşımı nedir? 6 yıllık deneyim

Öz

Amaç: Genel algı 80 yaş ve üzeri hastalarda, koroner bypass cerrahi (KBC) riskinin daha yüksek olduğu yönündedir. Bununla birlikte, KBC, perkütan koroner arter girişim ve tıbbi tedavinin ileri yaş hasta grubunda yaşam kalitesi üzerine etkileri kapsamlı bir şekilde değerlendirilmemiştir. Gereç ve Yöntemler: Çalışmamızda koroner anjiyografi yapılan 80 yaş ve üzeri 375 hastanın sağ-kalım süresi retrospektif olarak değerlendirildi. Sınırlı sağ-kalım üzerine bir tahmin modeli oluşturuldu. Bulgular: KAG verilerine göre, hastalar yedi grupta değerlendirildi: Grup 1, sonuçları normal olan hastalar; grup 2, lezyonlar için medikal tedavi alan hastalar; grup 3, PCI yapılan hastalar; grup 4, yalnızca sol ön inen arteri (LAD) veya koroner arterleriyle kombine olan hastalar; grup 5, herhangi bir müdahale için uygun bulunmayan kritik durumdaki hastalar; grup 6, KBC geçiren hastalar; grup 7, önerilen girişimleri reddeden hastalardır. İlk yıl sağ-kalım oranının en düşük Grup 5 ‘de ( % 76.1) olduğu tespit edilmiştir. 6 yıl sonra sağ-kalım oranının en yüksek grup 6 da olduğu görülmüştür (% 90.2). Yıllara göre yaşayan hasta oranlarına bakıldığında Grup 6 ile grup 2 ve grup 3 arasında (p=0.001, p = 0.004). Grup 3 ile grup 4 ve grup 7 arasında (p = 0.000) ve grup 7 ile grup 2 (p = 0.007) arasında ile anlamlı bir korelasyon bulundu. Sonuç : Bu çalışmada özellikle beklenen yaşam süresi kısa olan ileri yaş hastalarda, görsel anastomotik replasman ve tam vaskülarizasyonun cerrahi avantajı, PCI'den daha başarılı olmuştur.

Anahtar Kelimeler

• kardiyak cerrahi
• koroner bypass
• ileri yaş hastalar

What is the best medical approach in octogenarian patients with coronary artery disease? A 6-year experience

Öz

Aims: Best popular perception that coronary artery bypass grefting in octogenarians carries high risk related primarily to advanced age. Nevertheless, the effects of CABG, percutaneous coronary intervention , and medical treatment were not assessed on life adequately. Material and Methods: In the present study, survival duration of 375 octogenarian patients who underwent coronary angiography (CAG) in our clinic was evaluated retrospectively. Results: Patients were assigned and compare to seven groups as follows: group 1, patients with normal CAG results; group 2, patients with diffuse coronary narrowness who received medical treatment, group 3, patients who underwent PCI, group 4 was the subgroup of patients from group 3 who underwent PCI in the left anterior descending artery only or in combination with their coronary arteries; group 5, patients in critical condition who were unavailable for any intervention because of cardiac function, group 6, patients who underwent CABG; and group 7, patients who declined the recommended CABG and PCI. For each group, the first-year survival rates were respectively: 100%, 95%, 91.2%, 91.8%, 76.1%, 93.0%, 90.82%. After 6 years, the survival rates were respectively: 76.1%, 80.0%, 72.5%, 71.42%, 52.3%, 90.2%, 76.14%. Rates of patients living by years a significant correlation was revealed between group 6 and group 2 and group 3 (p=0.001, p = 0.004). Group 3 was found to have a significant correlation with Group 4 and Group 7 (p=.000). Group 7 was significantly correlated with groups 3 (p = 0.000), 4 (p = 0.000), and 2 (p = 0.007). Conclusion: Especially in octogenarians who had shortness of the expected survival, the surgical advantage of visual anastomotic replacement, and complete vascularization were successed more than PCI.

Anahtar Kelimeler

• cardiac disease
• coronary artery bypass grefting
• octagenarian

Kaynakça

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