Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Cardiol. 2010 Nov 15;106(10):1382-8. doi: 10.1016/j.amjcard.2010.07.008.
ST-segment elevation myocardial infarction (STEMI) is common in older adults and has high age-related mortality. We describe contemporary STEMI care using the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Network Registry-Get With The Guidelines (ACTION-GWTG) database. Patients with STEMI (n = 30,188) from 285 ACTION-GWTG sites from January 1, 2007 to June 30, 2008 were grouped by age (<75, 75 to 84, and ≥ 85 years) to compare baseline characteristics, reperfusion, and in-hospital outcomes. In this population, 79.7% (24,070) were <75 years old, 14.2% (4,273) were 75 to 84 years old, and 6.1% (1,845) were ≥ 85 years old (the oldest old). Compared to younger patients, the oldest-old patients (median age 88 years, interquartile range 86 to 91) were more often women, had more hypertension, and end-organ co-morbidity (heart failure and stroke, p <0.0001 for all). More than 42% of the oldest old were also cited as having contraindications to reperfusion, but with absolute or relative contraindications noted in only 10%, and patient preference was the most common reason indicated (45%). Even in reperfusion-eligible patients, the oldest old were less likely to receive it. Although patients who received reperfusion had better outcomes than those who did not, this was significant only for younger patients (< 75 years old, odds ratio 0.58, confidence interval 0.40 to 0.84). In conclusion, > 42% of the oldest old have reported contraindications to reperfusion, with neither mortality benefit nor harm in those who receive it. Disparities in process of care and co-morbidity may explain these observational findings. Whether efforts to optimize patient selection and initiate reperfusion therapy can improve outcomes in the oldest old with STEMI is unknown.
ST 段抬高型心肌梗死（STEMI）在老年人中较为常见，且与年龄相关的死亡率较高。我们使用美国国家心血管数据注册急性冠状动脉治疗和干预网络注册-遵循指南（ACTION-GWTG）数据库来描述当代 STEMI 的治疗情况。该研究纳入了 2007 年 1 月 1 日至 2008 年 6 月 30 日来自 285 个 ACTION-GWTG 站点的 30188 例 STEMI 患者，根据年龄（<75 岁、75-84 岁和≥85 岁）分组，以比较基线特征、再灌注和住院结局。在该人群中，79.7%（24070 例）年龄<75 岁，14.2%（4273 例）年龄为 75-84 岁，6.1%（1845 例）年龄≥85 岁（最年长组）。与年轻患者相比，最年长组（中位年龄 88 岁，四分位距 86-91 岁）患者更多为女性，合并更多的高血压和终末器官合并症（心力衰竭和卒中等，所有比较均 P<0.0001）。超过 42%的最年长患者也被认为存在再灌注禁忌证，但仅有 10%的患者存在绝对或相对禁忌证，患者意愿是最常见的原因（45%）。即使在有再灌注适应证的患者中，最年长患者接受再灌注的可能性也较低。尽管接受再灌注的患者预后优于未接受再灌注的患者，但这仅在年轻患者（<75 岁）中具有统计学意义（比值比 0.58，95%置信区间 0.40-0.84）。总之，>42%的最年长患者报告存在再灌注禁忌证，而接受再灌注治疗的患者既没有生存获益，也没有生存危害。治疗过程和合并症的差异可能解释了这些观察性发现。是否努力优化患者选择和启动再灌注治疗能否改善 STEMI 最年长患者的结局尚不清楚。
