老年人心肌梗死的临床表现。
The clinical manifestation of myocardial infarction in elderly patients.
机构信息
Department of Cardiology, Medical University of Lodz, Poland.
出版信息
Clin Cardiol. 2009 Jun;32(6):E46-51. doi: 10.1002/clc.20354.
BACKGROUND AND HYPOTHESIS
The study aimed to compare the clinical picture and treatment differences in elderly patients (aged 75 years or older) and younger patients (aged below 75 years).
METHODS
The study included 80 consecutive patients with myocardial infarction (MI) treated in the Cardiology Ward of the Specialist Hospital in Radom, Poland, in 2005. Analyses were performed retrospectively. The patients were separated into 2 groups according to age. The group I study group consisted of 40 patients aged 75 or over (aged 75-95; mean 81 years) and the group II control group consisted of 40 patients aged below 75 years (aged 42-67; mean 60 years).
RESULTS
In the elderly, as compared with younger subjects, dyspnea, fatigue, and other heart failure symptoms, were more frequently the first symptoms of MI than typical chest pain (p<0.05). ST-segment elevation myocardial infarction (STEMI) was also more common (p<0.05). Non-ST-segment elevation myocardial infarction (NSTEMI) was more frequently diagnosed in the elderly (p<0.05). In elderly patients there were more women (p<0.05), more patients with previously diagnosed ischemic heart disease (p<0.05), with hypertension (p<0.05), and with diabetes mellitus (p<0.05). Obesity was less frequently diagnosed in the elderly; however the difference was not statistically significant. Dyslipidemia and cigarette smoking were both significantly less common among elderly patients (p<0.05). The elderly were significantly less frequently revascularized (p<0.05). Both fibrinolysis and primary percutaneous coronary intervention (PCI) were less commonly applied to the elderly (p<0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (p<0.05). The MI complications and side effects of treatment seemed to be more frequent in the elderly, but only post-MI heart failure was observed more frequently in this group of patients (p<0.05).
CONCLUSIONS
Our observations confirm the differences in the clinical picture of MI in the elderly as described previously. All patients of advanced age should be considered as having the highest risk of death and complications occurrence.
背景与假设
本研究旨在比较 75 岁及以上老年患者和 75 岁以下年轻患者的临床表现和治疗差异。
方法
本研究纳入了 2005 年在波兰拉多姆专家医院心内科接受治疗的 80 例连续心肌梗死（MI）患者。分析为回顾性分析。根据年龄将患者分为两组。第 I 组研究组由 40 例 75 岁及以上的患者组成（年龄 75-95 岁，平均 81 岁），第 II 组对照组由 40 例 75 岁以下的患者组成（年龄 42-67 岁，平均 60 岁）。
结果
与年轻患者相比，老年患者呼吸困难、疲劳和其他心力衰竭症状更常作为 MI 的首发症状，而非典型胸痛（p<0.05）。ST 段抬高型心肌梗死（STEMI）也更为常见（p<0.05）。非 ST 段抬高型心肌梗死（NSTEMI）在老年患者中更为常见（p<0.05）。老年患者中女性更多（p<0.05），有先前诊断为缺血性心脏病（p<0.05）、高血压（p<0.05）和糖尿病（p<0.05）的患者更多。老年患者中肥胖的诊断较少，但差异无统计学意义。血脂异常和吸烟在老年患者中均明显较少（p<0.05）。老年患者再血管化治疗的比例明显较低（p<0.05）。溶栓和直接经皮冠状动脉介入治疗（PCI）在老年患者中应用均较少（p<0.05）。老年患者从症状发作到入院的时间明显较长（p<0.05）。老年患者的 MI 并发症和治疗副作用似乎更为常见，但只有心肌梗死后心力衰竭在该组患者中更为常见（p<0.05）。
结论
我们的观察结果证实了先前描述的老年患者 MI 临床表现的差异。所有高龄患者均应视为死亡和并发症发生风险最高的人群。
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