Cardiology Unit, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Ctra Madrid-Cartagena s/n Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
Age Ageing. 2013 Jan;42(1):70-5. doi: 10.1093/ageing/afs121. Epub 2012 Sep 14.
a significant proportion of octogenarian patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI) with stenting. Dual antiplatelet therapy is recommended in these patients, requiring a period of triple therapy with dual antiplatelet agent plus oral anticoagulation (OAC). Concerns remain regarding the appropriateness of OAC in octogenarians.
we reviewed 604 patients (15.7% ≥80 years) with AF undergoing PCI. Clinical follow-up was performed, recording any bleeding episode, thrombo-embolism and major adverse cardiac events (MACE = death, acute myocardial infarction and/or revascularisation of target lesion). We compared octogenarian patients in relation to treatment with OAC at discharge. A secondary aim was to compare octogenarian patients with non-octogenarian patients in terms of their clinical and demographic characteristics, management and clinical outcome.
among the 604 patients, 95(15.7%) were aged ≥80 years. Octogenarians had a higher median CHADS2 score (2.78 versus 2.01; P < 0.001) and HAS-BLED score (3.05 versus 2.84; P = 0.028). After a follow-up of 17 ± 14 months, all-cause death occurred in 33%, MACE in 44%, and major bleeding in 21%. OAC was associated with less MACE (28.9 versus 58.3%; P = 0.012) and a similar rate of major bleeding. On multivariable analysis, non-use of OAC at discharge was associated with increased MACE (OR = 4.3; 95% CI = 1.3-14.6; P = 0.02).
octogenarian AF patients undergoing PCI/stenting have a high mortality rate and MACE, which can be reduced by means of OAC therapy.
相当比例的 80 岁以上老年心房颤动（AF）患者接受经皮冠状动脉介入治疗（PCI）和支架植入术。这些患者推荐双联抗血小板治疗，需要双联抗血小板药物加口服抗凝剂（OAC）三联治疗一段时间。对于 80 岁以上患者使用 OAC 的适宜性仍存在担忧。
我们回顾了 604 例（15.7%≥80 岁）接受 PCI 的 AF 患者。进行临床随访，记录任何出血事件、血栓栓塞和主要不良心脏事件（MACE=死亡、急性心肌梗死和/或靶病变血运重建）。我们比较了出院时接受 OAC 治疗的 80 岁以上患者和未接受 OAC 治疗的患者。次要目的是比较 80 岁以上患者和非 80 岁以上患者的临床和人口统计学特征、管理和临床结局。
在 604 例患者中，95 例（15.7%）年龄≥80 岁。80 岁以上患者的中位 CHADS2 评分（2.78 比 2.01；P<0.001）和 HAS-BLED 评分（3.05 比 2.84；P=0.028）更高。随访 17±14 个月后，全因死亡发生 33%，MACE 发生 44%，大出血发生 21%。OAC 治疗与较少的 MACE（28.9%比 58.3%；P=0.012）和相似的大出血发生率相关。多变量分析显示，出院时未使用 OAC 与 MACE 增加相关（OR=4.3；95%CI=1.3-14.6；P=0.02）。
接受 PCI/支架植入术的 80 岁以上老年 AF 患者死亡率和 MACE 较高，OAC 治疗可降低 MACE 发生率。
