老年急性心肌梗死患者的院内死亡率：来自MITRA（急性心肌梗死最大个体化治疗）注册研究的数据。
In-hospital mortality of elderly patients with acute myocardial infarction: data from the MITRA (Maximal Individual Therapy in Acute Myocardial Infarction) registry.
作者信息
Haase K K, Schiele R, Wagner S, Fischer F, Burczyk U, Zahn R, Schuster S, Senges J
机构信息
Heart Center Ludwigshafen, Germany.
出版信息
Clin Cardiol. 2000 Nov;23(11):831-6. doi: 10.1002/clc.4960231109.
BACKGROUND
Advanced age remains one of the principal determinants of mortality in patients with acute myocardial infarction (AMI).
HYPOTHESIS
The aim of this study was to determine the in-hospital outcome of elderly (> 75 years) patients with AMI who were admitted to hospitals participating in the national MITRA (Maximal Individual Therapy in Acute Myocardial Infarction) registry.
METHODS
MITRA is a prospective, observational German multicenter registry investigating current treatment modalities for patients presenting with AMI. All patients with AMI admitted within 96 h of onset of symptoms were included in the MITRA registry. MITRA was started in June 1994 and ended in January 1997. This registry comprises 6,067 consecutive patients with a mean age of 65 +/- 12 years, of whom 1,430 (17%) were aged > 75 years. Patients were compared with respect to patient characteristics, prehospital delays, early treatment strategies, and clinical outcome.
RESULTS
In the elderly patient population, the prehospital delay was 210 min, which was significantly longer than that for younger patients (155 min, p = 0.001). Although the incidence of potential contraindications for the initiation of thrombolysis was almost equally distributed between the two age groups (8.7 vs. 8.2%, p = NS), elderly patients (> 75 years) received reperfusion therapy less frequently (35.9 vs. 64.6%) than younger patients. Mortality increased with advanced age and was 26.4% for all patients aged > 75 years. If reperfusion therapy was initiated, in-hospital mortality was 21.8 versus 28.9% in patients aged > 75 years (p = 0.001) and 29.4 versus 38.5% in patients aged > 85 years (p = 0.001).
CONCLUSION
In this registry, elderly patients with AMI had a much higher in-hospital mortality than that expected from randomized trials. In MITRA, the mortality reduction with reperfusion therapy was found to be highest in the very elderly patient population.
背景
高龄仍然是急性心肌梗死（AMI）患者死亡的主要决定因素之一。
假设
本研究的目的是确定参与全国性MITRA（急性心肌梗死最大个体化治疗）登记系统的医院中，老年（>75岁）AMI患者的院内结局。
方法
MITRA是一项前瞻性、观察性的德国多中心登记系统，旨在研究AMI患者当前的治疗方式。所有在症状发作96小时内入院的AMI患者均纳入MITRA登记系统。MITRA于1994年6月启动，1997年1月结束。该登记系统包括6067例连续患者，平均年龄为65±12岁，其中1430例（17%）年龄>75岁。对患者的特征、院前延误时间、早期治疗策略和临床结局进行了比较。
结果
在老年患者群体中，院前延误时间为210分钟，显著长于年轻患者（155分钟，p = 0.001）。尽管启动溶栓治疗的潜在禁忌证发生率在两个年龄组中几乎相同（8.7%对8.2%，p = 无显著性差异），但老年患者（>75岁）接受再灌注治疗的频率低于年轻患者（35.9%对64.6%）。死亡率随年龄增长而增加，所有年龄>75岁的患者死亡率为26.4%。如果启动再灌注治疗，>75岁患者的院内死亡率为21.8%，而年轻患者为28.9%（p = 0.001）；>85岁患者的院内死亡率为29.4%，而年轻患者为38.5%（p = 0.001）。
结论
在该登记系统中，老年AMI患者的院内死亡率远高于随机试验预期的死亡率。在MITRA中，发现再灌注治疗对高龄患者群体的死亡率降低效果最为显著。
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