梗死前心绞痛对接受冠状动脉介入治疗的老年前壁急性心肌梗死患者住院结局的有益影响得以保留。

Beneficial effect of preinfarction angina on in-hospital outcome is preserved in elderly patients undergoing coronary intervention for anterior acute myocardial infarction.

作者信息

Kosuge Masami, Kimura Kazuo, Kojima Sunao, Sakamoto Tomohiro, Ishihara Masaharu, Asada Yujiro, Tei Chuwa, Miyazaki Shunichi, Sonoda Masahiro, Tsuchihashi Kazufumi, Yamagishi Masakazu, Ikeda Yoshihiko, Shirai Mutsunori, Hiraoka Hisatoyo, Inoue Takeshi, Saito Fumio, Ogawa Hisao

机构信息

Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.

出版信息

Circ J. 2005 Jun;69(6):630-5. doi: 10.1253/circj.69.630.

DOI:10.1253/circj.69.630

PMID:15914937

Abstract

BACKGROUND

Preinfarction angina improves survival after acute myocardial infarction (AMI) in nonelderly but not elderly patients in the thrombolytic era. However, it remains unclear whether preinfarction angina has a beneficial effect on clinical outcome in elderly patients undergoing percutaneous coronary intervention (PCI).

METHODS AND RESULTS

The study group comprised 484 anterior AMI patients who were admitted within 24 h of onset and underwent emergency PCI. Patients were divided into 2 groups: those aged < 70 years (nonelderly patients, n = 290) and those aged > or = 70 years (elderly patients, n = 194). Angina within 24 h before AMI was present in 42% of nonelderly patients and in 37% of elderly patients. In nonelderly patients, preinfarction angina was associated with a lower in-hospital mortality rate (1% vs 7%, p = 0.02). Similarly, in elderly patients, preinfarction angina was associated with a lower in-hospital mortality rate (6% vs 16%, p = 0.03). Multivariate analysis showed that the absence of preinfarction angina was an independent predictor of in-hospital mortality in both nonelderly (odds ratio 4.20; 95% confidence interval (CI) 1.20-10.6; p = 0.04) and elderly patients (odds ratio 3.04; 95%CI 1.06-18.1; p = 0.04).

CONCLUSIONS

Angina within the 24 h before AMI is associated with better in-hospital outcomes in elderly and nonelderly patients.

摘要

背景

在溶栓治疗时代，梗死前心绞痛可改善非老年患者急性心肌梗死（AMI）后的生存率，但对老年患者无效。然而，目前尚不清楚梗死前心绞痛对接受经皮冠状动脉介入治疗（PCI）的老年患者的临床结局是否具有有益影响。

方法与结果

研究组包括484例急性前壁心肌梗死患者，这些患者在发病后24小时内入院并接受了急诊PCI治疗。患者分为两组：年龄<70岁的患者（非老年患者，n = 290）和年龄≥70岁的患者（老年患者，n = 194）。42%的非老年患者和37%的老年患者在AMI前24小时内出现心绞痛。在非老年患者中，梗死前心绞痛与较低的住院死亡率相关（1%对7%，p = 0.02）。同样，在老年患者中，梗死前心绞痛也与较低的住院死亡率相关（6%对16%，p = 0.03）。多因素分析显示，无梗死前心绞痛是老年患者和非老年患者住院死亡率的独立预测因素（非老年患者：比值比4.20；95%置信区间（CI）1.20 - 10.6；p = 0.04；老年患者：比值比3.04；95%CI 1.06 - 18.1；p = 0.04）。