Cardiology Department, Maggiore Hospital, Bologna, Italy.
J Cardiovasc Med (Hagerstown). 2012 Mar;13(3):165-74. doi: 10.2459/JCM.0b013e3283515be3.
Guideline-recommended therapies for acute coronary syndromes (ACS) derive from randomized trials in which elderly patients are underrepresented. Although numbers of this population are increasing, they are largely undertreated in the real world.
The study evaluates the impact of older age on care for patients with ACS admitted to the Italian Intensive Cardiac Care Units (ICCUs) network.
We analyzed data from the BLITZ-3 Registry in order to assess in-hospital care among unselected elderly patients (≥75 years).
From 7-20 April 2008, 6986 consecutive patients with acute cardiac conditions were admitted to ICCUs and prospectively enrolled; 3636 (52%) had ACS and 38% of them were elderly. Elderly patients had a higher risk profile, their median length of stay in ICCU was longer [4 days, interquartile range (IQR): 3-6 vs. 3 days, IQR: 2-5; P < 0.0001] and guideline-recommended care was applied less often. At multivariable analysis, elderly patients were less likely to receive reperfusion [odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.42-0.67] for ST-elevation, or early coronary angiography (OR = 0.45, 95% CI = 0.37-0.56) for non-ST elevation ACS. Besides, unadjusted in-ICCU total mortality was higher for elderly patients with ST-elevation (11.8% elderly vs. 1.8% younger patients; P < 0.0001) or non-ST-elevation (3.9% elderly vs. 0.6% younger patients; P < 0.0001) ACS.
In a nationwide survey, age impacts on care. The elderly with ACS have a higher risk profile but receive less guideline-recommended care than younger patients. Thus, further improvements in care of this population should be pursued.
急性冠状动脉综合征（ACS）的指南推荐疗法源自随机临床试验，这些试验中老年人代表性不足。尽管这个人群的数量正在增加，但在现实世界中，他们在很大程度上未得到充分治疗。
本研究评估年龄对意大利重症监护心脏病房（ICCUs）网络收治的 ACS 患者护理的影响。
我们分析了 BLITZ-3 登记处的数据，以评估未选择的老年患者（≥75 岁）的住院期间护理情况。
2008 年 4 月 7 日至 20 日，6986 例急性心脏疾病患者连续入住 ICCUs 并进行前瞻性登记；其中 3636 例（52%）患有 ACS，其中 38%为老年人。老年患者的风险状况更高，他们在 ICCU 的中位住院时间更长[4 天，四分位距（IQR）：3-6 比 3 天，IQR：2-5；P<0.0001]，并且较少接受指南推荐的治疗。多变量分析显示，老年患者接受再灌注治疗的可能性较低[ST 段抬高的优势比（OR）=0.53，95%置信区间（CI）=0.42-0.67]或早期冠状动脉造影术（非 ST 段抬高 ACS 的 OR=0.45，95%CI=0.37-0.56）的可能性较低。此外，ST 段抬高 ACS 的老年患者未经调整的 ICU 内总死亡率较高（11.8%的老年患者比 1.8%的年轻患者；P<0.0001）或非 ST 段抬高 ACS（3.9%的老年患者比 0.6%的年轻患者；P<0.0001）。
在一项全国性调查中，年龄会影响护理。患有 ACS 的老年人风险状况更高，但接受的指南推荐治疗比年轻患者少。因此，应进一步改善这一人群的护理。
