老年急性心肌梗死并心原性休克患者行经皮冠状动脉介入治疗的生存情况。

Survival of elderly patients undergoing percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock.

机构信息

Department of Cardiology, Austin Hospital, Melbourne, Australia.

出版信息

JACC Cardiovasc Interv. 2009 Feb;2(2):146-52. doi: 10.1016/j.jcin.2008.11.006.

DOI:10.1016/j.jcin.2008.11.006

PMID:19463417

Abstract

OBJECTIVES

We sought to assess clinical outcomes of elderly patients (age >or=75 years) undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) in a contemporary multicenter PCI registry.

BACKGROUND

Although benefits of early PCI have been shown in younger groups, few studies have reported on clinical outcomes in elderly shock patients using current PCI techniques.

METHODS

We analyzed baseline characteristics and procedural and clinical outcomes in 143 consecutive patients presenting with MI and CS who underwent PCI from the Melbourne Interventional Group registry between 2004 and 2007.

RESULTS

Of the 143 patients, 31.5% (n = 45) were elderly and 68.5% were younger (age <75 years). Elderly patients were more likely to be female (46.7% vs. 22.4%, p < 0.01) and have hypertension (77.8% vs. 46.4%, p < 0.01), previous MI (31.1% vs. 15.5%, p = 0.03), renal failure (24.4% vs. 11.3%, p < 0.05) and multivessel coronary artery disease (93.1% vs. 68.3%, p < 0.01). Stent (86.7% vs. 94.8%, p = 0.09), glycoprotein IIb/IIIa inhibitor (68.9% vs. 65.3%, p = 0.67), and intra-aortic balloon pump (57.8% vs. 58.2%, p = 0.97) use were similar in both groups. In-hospital, 30-day, and 1-year mortality in the elderly group versus the younger group were 42.2% vs. 33.7% (p = 0.32), 43.2% vs. 36.1% (p = 0.42), and 52.6% vs. 46.8% (p = 0.56), respectively.

CONCLUSIONS

In this study, the 1-year survival of elderly patients with acute MI complicated by CS undergoing PCI was comparable to younger patients. These data suggest that in elderly patients presenting with CS, benefit is possible with selective use of early revascularization and merits further investigation.

摘要

目的

我们旨在评估在当代多中心经皮冠状动脉介入治疗（PCI）注册研究中，年龄≥75 岁的急性心肌梗死（MI）合并心源性休克（CS）患者行 PCI 的临床结果。

背景

尽管年轻患者的早期 PCI 已显示出获益，但很少有研究报告使用当前 PCI 技术治疗老年休克患者的临床结果。

方法

我们分析了 2004 年至 2007 年期间，墨尔本介入治疗组注册研究中 143 例 MI 合并 CS 并接受 PCI 的连续患者的基线特征、手术和临床结果。

结果

143 例患者中，31.5%（n=45）为老年人，68.5%为年轻人（年龄<75 岁）。老年患者更可能为女性（46.7%比 22.4%，p<0.01）和患有高血压（77.8%比 46.4%，p<0.01）、既往有心肌梗死（31.1%比 15.5%，p=0.03）、肾功能衰竭（24.4%比 11.3%，p<0.05）和多支冠状动脉疾病（93.1%比 68.3%，p<0.01）。支架（86.7%比 94.8%，p=0.09）、糖蛋白 IIb/IIIa 抑制剂（68.9%比 65.3%，p=0.67）和主动脉内球囊泵（57.8%比 58.2%，p=0.97）的使用在两组间相似。与年轻组相比，老年组住院期间、30 天和 1 年死亡率分别为 42.2%比 33.7%（p=0.32）、43.2%比 36.1%（p=0.42）和 52.6%比 46.8%（p=0.56）。