I. Medizinische Klinik, Hospital of Augsburg, teaching hospital of the Ludwig Maximilians University München, Augsburg, Germany.
I. Medizinische Klinik, Hospital of Augsburg, teaching hospital of the Ludwig Maximilians University München, Augsburg, Germany.
Int J Cardiol. 2011 Jun 2;149(2):205-210. doi: 10.1016/j.ijcard.2010.01.010. Epub 2010 Feb 16.
With increasing life expectancy the management of acute myocardial infarction (AMI) in patients of an older age is of growing importance. However, long-term data are limited regarding 'hard' endpoints and quality of life in unselected elderly patients in 'real world' settings.
From March 2005 to March 2006 all 75-84-year old patients consecutively hospitalised due to an incident AMI in a large community teaching hospital were analyzed (N=235). Evidence-based therapy included the treatment with aspirin (93%), clopidogrel (65%), betablockers (93%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (84%), and statins (83%). Percutaneous coronary intervention (PCI) was performed in 45.5% and bypass grafting (CABG) in 10.2%. The 28-day-case fatality was 17.4%. Long-term follow-up was obtained in 95.9% of all hospital survivors at a mean of 18.7 ± 6.4 months; during this time 19.9% of patients died. After multivariate analysis the only significantly negative predictor for survival and MACCE was diabetes, and the only significantly positive predictor was revascularisation during hospital stay. Patients with PCI/CABG had lower NYHA class (81% vs. 48%; p<0.04). Patients with PCI also had a higher EQ-5D index score (75 ± 18 vs. 67 ± 17, p<0.04) compared to patients not receiving PCI.
The positive long-time effect of revascularisation procedures during hospitalisation, not only on 'hard' endpoints but also on functional outcome and quality of life emphasizes that invasive therapies should not be considered less valuable in elderly people and that age alone should not preclude aggressive treatment during AMI.
随着预期寿命的延长，对年龄较大的急性心肌梗死（AMI）患者的管理变得越来越重要。然而，在“真实世界”环境中，针对未经选择的老年患者的“硬终点”和生活质量，长期数据有限。
从 2005 年 3 月至 2006 年 3 月，对一家大型社区教学医院因偶发 AMI 住院的所有 75-84 岁患者（N=235）进行了分析。循证治疗包括使用阿司匹林（93%）、氯吡格雷（65%）、β受体阻滞剂（93%）、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（84%）和他汀类药物（83%）。45.5%的患者进行了经皮冠状动脉介入治疗（PCI），10.2%的患者进行了冠状动脉旁路移植术（CABG）。28 天病死率为 17.4%。所有住院幸存者中有 95.9%在平均 18.7±6.4 个月时获得了长期随访；在此期间，19.9%的患者死亡。多变量分析后，唯一显著的生存和 MACCE 负预测因素是糖尿病，唯一显著的正预测因素是住院期间的血运重建。接受 PCI/CABG 的患者 NYHA 分级较低（81% vs. 48%；p<0.04）。接受 PCI 的患者 EQ-5D 指数评分也较高（75±18 与 67±17，p<0.04）。
住院期间血运重建术的积极长期效果，不仅对“硬终点”，而且对功能结局和生活质量都有影响，这强调了侵入性治疗在老年人中不应被认为价值较低，而且年龄本身不应排除在 AMI 期间的积极治疗。
