Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN 55407, USA.
Am Heart J. 2011 Apr;161(4):664-72. doi: 10.1016/j.ahj.2010.12.018.
We hypothesized that older patients in a regional ST-elevation myocardial infarction (STEMI) transfer program would attain comparable treatment to younger patients.
Older patients have been either excluded or underrepresented in STEMI clinical trials. Observational studies suggest that these patients are less likely to receive adjunctive pharmacologies and reperfusion therapy-thrombolysis or percutaneous coronary intervention (PCI)-and therapy is frequently delayed.
We identified a consecutive series of 2,262 STEMI patients (March 2003-December 2008) who either presented or were transferred to Abbott Northwestern Hospital for PCI (<65 years [n = 1285], 65-74 years [n = 436], 75-84 years [n = 381], and ≥85 years [n = 160]). Main outcome measures included time-to-reperfusion therapy, adjunctive medications received, and all-cause mortality.
Overall time-to-reperfusion therapy was similar across age strata-94 minutes (<65 years), 101 minutes (65-74 years), 106 minutes (75-84 years), and 103 minutes (≥85 years). No difference in adjunctive antiplatelet or anticoagulant medications was seen at hospital admission, and only slight differences in standard post-myocardial infarction medication use were seen by age at hospital discharge. Age was an independent predictor of in-hospital and yearly mortality up to 5 years (1-year mortality 3.4% [<65 years], 9.2% [65-74 years], 15.2% [75-84 years], and 28.9% [≥85 years]; P < .0001).
Older patients receive similar care to younger patients when treated in a regional STEMI transfer program. Although all-cause mortality in the elderly is increased, the absolute rates are lower than previously established. Our data suggest primary PCI (including transfer) can be applied to all appropriate STEMI patients, regardless of age.
我们假设在区域性 ST 段抬高型心肌梗死（STEMI）转院治疗项目中，老年患者可获得与年轻患者相当的治疗效果。
在 STEMI 临床试验中，老年患者被排除在外或代表性不足。观察性研究表明，这些患者接受辅助药物治疗和再灌注治疗（溶栓或经皮冠状动脉介入治疗[PCI]）的可能性较小，且治疗往往延迟。
我们确定了连续的 2262 例 STEMI 患者（2003 年 3 月至 2008 年 12 月），他们是直接到雅培西北医院接受 PCI 的患者（＜65 岁[1285 例]，65-74 岁[436 例]，75-84 岁[381 例]和≥85 岁[160 例]）。主要观察指标包括再灌注治疗时间、接受的辅助药物和全因死亡率。
各年龄组的总体再灌注治疗时间相似-94 分钟（＜65 岁），101 分钟（65-74 岁），106 分钟（75-84 岁）和 103 分钟（≥85 岁）。入院时辅助抗血小板或抗凝药物没有差异，出院时根据年龄观察到标准心肌梗死药物的使用仅有细微差异。年龄是住院期间和 5 年内每年死亡率的独立预测因素（1 年死亡率 3.4%（＜65 岁），9.2%（65-74 岁），15.2%（75-84 岁）和 28.9%（≥85 岁）；P＜0.0001）。
在区域性 STEMI 转院治疗项目中，老年患者接受与年轻患者相似的治疗。尽管老年患者的全因死亡率增加，但绝对比率低于之前确定的比率。我们的数据表明，直接 PCI（包括转院）可适用于所有合适的 STEMI 患者，无论年龄大小。
