Mehta Rajendra H, Sadiq Immad, Goldberg Robert J, Gore Joel M, Avezum Alvaro, Spencer Frederick, Kline-Rogers Eva, Allegrone Jeanna, Pieper Karen, Fox Keith A A, Eagle Kim A
University of Michigan, Ann Arbor, Mich, USA.
Am Heart J. 2004 Feb;147(2):253-9. doi: 10.1016/j.ahj.2003.08.007.
Few data exist from a community-based perspective on the relative effectiveness of primary percutaneous coronary intervention (PCI) as compared with thrombolytic therapy (TT) in elderly patients with ST-elevation myocardial infarction (STEMI), particularly in the current era of coronary stents and newer antithrombotic agents.
We evaluated data from patients, aged > or =70 years, with STEMI who were enrolled in the Global Registry of Acute Coronary Events study between April 1999, and September 2002.
Of the 2975 elderly patients eligible for reperfusion therapy, 365 (12.7%) underwent primary PCI and 769 (26.7%) received TT. The median delay from hospital arrival to therapy was 105 minutes for primary PCI and 40 minutes for TT. Inhospital complications for primary PCI versus TT included mortality (13.5% vs 14.8%), reinfarction (1.1% vs 5.7%), composite of death or reinfarction (14.3% vs 18.7%), cardiogenic shock (11.3% vs 11.6%), major bleeding (8.6% vs 5.9%), and stroke (1.1% vs 2.8%). After adjustment for baseline differences and propensity score, patients receiving primary PCI showed a lower rate of reinfarction (odds ratio [OR], 0.15; 95% CI, 0.05-0.44) and mortality (OR, 0.62; 95% CI, 0.39-0.96) and the composite of reinfarction or death (OR, 0.53; 95% CI, 0.35-0.79), with no difference in other outcome measures.
Our data suggest that, compared with TT, primary PCI is associated with a decrease in reinfarction and mortality, with no change in other outcome measures, in elderly patients with STEMI. These findings from an observational registry require further confirmation in future randomized clinical trial assessing the optimal reperfusion strategy in the elderly cohort with STEMI.
从社区角度来看，关于老年ST段抬高型心肌梗死（STEMI）患者中，与溶栓治疗（TT）相比，直接经皮冠状动脉介入治疗（PCI）的相对有效性的数据很少，尤其是在当前冠状动脉支架和新型抗血栓药物的时代。
我们评估了1999年4月至2002年9月期间纳入全球急性冠状动脉事件注册研究的年龄≥70岁的STEMI患者的数据。
在2975例符合再灌注治疗条件的老年患者中，365例（12.7%）接受了直接PCI，769例（26.7%）接受了TT。从入院到治疗的中位延迟时间，直接PCI为105分钟，TT为40分钟。直接PCI与TT的院内并发症包括死亡率（13.5%对14.8%）、再梗死率（1.1%对5.7%）、死亡或再梗死的复合发生率（14.3%对18.7%）、心源性休克（11.3%对11.6%）、大出血（8.6%对5.9%）和卒中（1.1%对2.8%）。在对基线差异和倾向评分进行调整后，接受直接PCI的患者再梗死率（优势比[OR]，0.15；95%可信区间，0.05 - 0.44）、死亡率（OR，0.62；95%可信区间，0.39 - 0.96）以及再梗死或死亡的复合发生率（OR，0.53；95%可信区间，0.35 - 0.79）较低，其他结局指标无差异。
我们的数据表明，在老年STEMI患者中，与TT相比，直接PCI与再梗死和死亡率降低相关，其他结局指标无变化。这些来自观察性注册研究的结果需要在未来评估老年STEMI患者最佳再灌注策略的随机临床试验中进一步证实。
