de Labriolle Axel, Giraudeau Bruno, Pacouret Gérard, Desveaux Bernard, Quilliet Laurent, Charbonnier Bernard, Fauchier Laurent
Département de Cardiologie, Centre Hospitalier Universitaire Tours, Tours, France.
Cardiovasc Revasc Med. 2007 Apr-Jun;8(2):90-3. doi: 10.1016/j.carrev.2006.12.002.
In the elderly patients, the optimal reperfusion strategy of acute ST-segment elevation myocardial infarction (STEMI) remains a topic of debate. Moreover, there is a lack of data regarding the effect of time to treatment (TT) on prognosis of STEMI in elderly patients.
The goal of our work was to analyze, in real life, the link between TT and 1-year mortality in patients with STEMI (> or =75 years) who were treated with thrombolysis (THL) or primary percutaneous coronary intervention (PCI).
Data were extracted from our university hospital prospective registry. Between 1995 and 2005, all patients who met the criteria (> or =75 years old, has had an acute STEMI <12 h, has been admitted directly into our cardiologic care unit, and has had a revascularization procedure) were included in the analysis. Using logistic regression, we studied the relation between TT and 1-year mortality for each strategy of reperfusion in patients with STEMI who were > or =75 years old.
One hundred fifty-nine consecutive patients with STEMI <12 h were analyzed; 35 were treated with THL and 124 were treated with primary PCI. Mean age (+/-S.D.) was 80+/-4 years, and 56% of patients were men. In logistic regression analysis, TT was not associated to death after THL (P=.81), while it was positively correlated after PCI (P=.03). All-cause 1-year mortality was markedly higher in the THL group than in the PCI group (51.4% vs. 15.3%; P<.001).
Our work suggests that the extrapolation of algorithm of revascularization used in younger patients is not appropriate for elderly patients. Specific algorithm of revascularization and recommendations are needed in elderly patients.
在老年患者中，急性ST段抬高型心肌梗死（STEMI）的最佳再灌注策略仍是一个有争议的话题。此外，关于治疗时间（TT）对老年STEMI患者预后影响的数据也很缺乏。
我们研究的目的是在实际临床中分析接受溶栓治疗（THL）或直接经皮冠状动脉介入治疗（PCI）的STEMI患者（年龄≥75岁）的TT与1年死亡率之间的关系。
数据来自我们大学医院的前瞻性登记系统。纳入1995年至2005年间所有符合标准（年龄≥75岁、急性STEMI发病<12小时、直接入住我们的心脏病监护病房且接受了血运重建治疗）的患者进行分析。我们采用逻辑回归分析，研究年龄≥75岁的STEMI患者每种再灌注策略下TT与1年死亡率之间的关系。
对159例连续的发病<12小时的STEMI患者进行了分析；其中35例接受了THL治疗，124例接受了直接PCI治疗。平均年龄（±标准差）为80±4岁，56%的患者为男性。逻辑回归分析显示，THL治疗后TT与死亡无相关性（P = 0.81），而PCI治疗后TT与死亡呈正相关（P = 0.03）。THL组的全因1年死亡率显著高于PCI组（51.4%对15.3%；P<0.001）。
我们的研究表明，将用于年轻患者的血运重建算法外推至老年患者并不合适。老年患者需要特定的血运重建算法和建议。
