Department of Cardiology, Goodhope Hospital, Sutton Coldfield, West Midlands, United Kingdom.
Cardiol J. 2012;19(4):395-401. doi: 10.5603/cj.2012.0071.
The number of elderly patients that present with an acute coronary syndrome (ACS) is increasing, reflecting the growing number of people in the general population in this age group. The various guidelines do not generally specify a management strategy in this elderly group and the management is often at the discretion of the treating physician. We conducted an audit within our Cardiology Department to compare our practice of management of ACS in the elderly population based on the European Society of Cardiology guidelines.
We conducted a retrospective analysis of the management of patients aged 80 and above that were admitted with troponin positive chest pain from 1(st) January to 31(st) December 2010. Patient information was primarily obtained from our computer data base system that includes blood results, ECHOs, diagnostic angiograms, discharge and clinic letters. If the information was inadequate we obtained patient files or contacted the relevant general practitioner.
Octo-nonagenarians represented just over a third (35%) of all patients that were admitted with a troponin positive event during the study period. We noted a 10% mortality rate observed in our study population over a 12 month period. Atrial fibrillation was an incidental finding in 22% of patients. Nearly half of these patients (49%) were managed by the cardiologists. 68% of these patients underwent diagnostic coronary angiography, of which 32% went on to have percutaneous coronary intervention and 7% underwent surgical intervention. Majority (80%) of patients that underwent angioplasty had more than 1 stent and 74% of patients required more than one coronary vessel to be stented. The length of stay in hospital was double for patients who were under the care of the general medical teams rather than the cardiology team. This group also had a higher number of other comorbidities such as dementia, malignancy, a history of gastro intestinal bleeds and chronic renal impairment.
Octo and nonagenarians represent a significant proportion of our ACS patients. They have high mortality, greater number of comorbidities, diseased coronary vessels and if intervention was undertaken required more than one stent. Therefore, octo-nonagenarians represent a very complex group of patients. Guidelines and risk stratification are of limited value in this group as clinical trial data is currently lacking. Quality of life and risk to benefit assessments are of paramount importance in this group.
患有急性冠状动脉综合征（ACS）的老年患者数量不断增加，这反映出该年龄段人群在总人口中所占比例不断增加。各指南通常并未针对该老年人群指定具体的管理策略，其管理通常由主治医生自行决定。我们在心脏病科进行了一项审计，以根据欧洲心脏病学会指南比较我们对老年人群 ACS 的管理实践。
我们对 2010 年 1 月 1 日至 12 月 31 日因肌钙蛋白阳性胸痛而入院的 80 岁及以上患者的管理情况进行了回顾性分析。患者信息主要从包括血液检查结果、ECHO、诊断性血管造影、出院和门诊信件在内的计算机数据库系统中获取。如果信息不充分，我们会获取患者的病历或联系相关的全科医生。
在研究期间，接受肌钙蛋白阳性事件入院的患者中，80 岁及以上的患者约占三分之一（35%）。我们发现，在 12 个月的研究期间，研究人群的死亡率为 10%。在 22%的患者中发现了心房颤动，其中近一半（49%）由心脏病专家管理。这些患者中有 68%接受了诊断性冠状动脉造影检查，其中 32%进行了经皮冠状动脉介入治疗，7%进行了手术干预。接受血管成形术的大多数（80%）患者放置了一个以上的支架，74%的患者需要放置一个以上的冠状动脉支架。与由普通医疗团队而不是心脏病团队护理的患者相比，住院时间延长了一倍。此类患者还具有更多的其他合并症，如痴呆、恶性肿瘤、胃肠道出血和慢性肾功能不全病史。
80 岁及以上的患者是我们 ACS 患者中的重要组成部分。他们的死亡率较高，合并症较多，病变冠状动脉较多，如果进行干预，则需要放置一个以上的支架。因此，80 岁及以上的患者代表了一组非常复杂的患者。该人群的指南和风险分层的作用有限，因为目前缺乏临床试验数据。在该人群中，生活质量和风险获益评估至关重要。
