Dept of Cardiology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Sydney, Australia.
EuroIntervention. 2012 Dec 20;8(8):912-9. doi: 10.4244/EIJV8I8A140.
Patients aged ≥80 years are often excluded or under-represented in trials assessing treatment modalities in STEMI. We assessed in-patient outcomes in elderly patients undergoing contemporary primary PCI (PPCI).
From Sept 2005 to July 2011 patients undergoing PPCI in our centre were identified. Demographic details, procedural data and in-patient outcomes were collated. Those aged ≥80 years were compared with those aged <80 years. In the study period 1,218 patients required PPCI, of which 224(18.4%) were ≥80 years. The elderly cohort were more likely to be female (44.3% vs. 20.3%; p<0.001), and have significant comorbidities. Times from first medical contact until TIMI 3 flow were similar between the two groups (medien 102 min vs. 109 min; p=0.19). There was no difference in rates of PCI success (97.3% vs. 98.3%; p=0.24), drug-eluting stent use (63.5% vs. 63.3%; p=1.00) and number of stents used. In-patient outcomes were worse in the elderly cohort with significantly higher rates of death (11.2% vs. 3.7%; p<0.001) and acute kidney injury (12.9% vs. 4.0%; p<0.001), with a trend towards more post-procedure cardiovascular accidents (CVA), access site complications and reinfarction. Length of stay was significantly longer in the elderly cohort (median days 5 vs. 3; p<0.001).
Important demographic differences exist in very elderly patients presenting with STEMI compared to younger patients though procedural data and PCI success rates are similar between the two groups. Those aged ≥80 years have significantly worse in-patient outcomes though death rates are not as high as historical data suggests.
在评估 STEMI 治疗方式的试验中，年龄≥80 岁的患者通常被排除或代表性不足。我们评估了接受当代经皮冠状动脉介入治疗（PPCI）的老年患者的住院结局。
从 2005 年 9 月至 2011 年 7 月，确定了在我们中心接受 PPCI 的患者。收集了人口统计学细节、程序数据和住院结局。将年龄≥80 岁的患者与年龄<80 岁的患者进行比较。在研究期间，有 1218 名患者需要 PPCI，其中 224 名（18.4%）≥80 岁。老年组更可能为女性（44.3%比 20.3%；p<0.001），且合并症更多。两组从首次医疗接触到 TIMI 3 级血流的时间相似（中位数 102 分钟比 109 分钟；p=0.19）。两组的 PCI 成功率（97.3%比 98.3%；p=0.24）、药物洗脱支架使用率（63.5%比 63.3%；p=1.00）和支架使用数量均无差异。老年组的住院结局更差，死亡率（11.2%比 3.7%；p<0.001）和急性肾损伤（12.9%比 4.0%；p<0.001）发生率明显更高，且术后心血管事件（CVA）、入路部位并发症和再梗死发生率有增加趋势。老年组的住院时间明显更长（中位数 5 天比 3 天；p<0.001）。
与年轻患者相比，STEMI 发作的极老年患者存在重要的人口统计学差异，尽管两组的程序数据和 PCI 成功率相似。≥80 岁的患者住院结局明显更差，尽管死亡率没有历史数据显示的那么高。
