Cardiol J. 2013;20(1):34-43. doi: 10.5603/CJ.2013.0007.
Elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) are rarely included in randomized trials due to concomitant diseases. As a result, invasive treatment and aggressive pharmacotherapy are used less frequently in this group. The aim of the study was to analyze the impact of invasive treatment used for elderly patients (≥ 80 years) with NSTEMI from 2003-2009 and its impact on 24-month outcomes.
We performed analysis of 13,707 elderly patients, out of 78,422 total NSTEMI patients, enrolled in the prospective, nationwide, Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2003 to 2009.
The percentage of elderly NSTEMI population was 17.5%. Invasive treatment received 24% of them. In-hospital complications (stroke, reinfarction and death) were significantly less frequent in the invasive group, with the exception of major bleeding, which occurred almost three times more frequently (2.9% vs. 1.1%, p < 0.0001) in the invasive group. The 24-month mortality was lower (29.4% vs. 50.4%, p < 0.0001) in the invasive group and remained so after matching patients by the propensity score method (31.1% vs. 40.9%, p < 0.0001). From 2003 to 2009 the use of thienopyridines, beta-blockers and statins rose significantly. The frequency of invasive strategy increased significantly, from 10% in to over 50% in 2009. The frequency of major bleeding increased twofold, however a significant reduction in the 24-month mortality was observed over the years.
Elderly patients with NSTEMI benefit significantly from invasive strategies and modern pharmacotherapy recommended by treatment guidelines. Nevertheless, this approach is associated with an increased incidence of major bleeding.
由于合并症的原因，非 ST 段抬高型心肌梗死（NSTEMI）的老年患者很少被纳入随机试验。因此，这组患者较少接受有创治疗和强化药物治疗。本研究旨在分析 2003-2009 年用于老年 NSTEMI 患者（≥80 岁）的有创治疗的影响及其对 24 个月结局的影响。
我们对 2003 年至 2009 年纳入前瞻性、全国性波兰急性冠状动脉综合征注册研究（PL-ACS）的 78422 例 NSTEMI 患者中的 13707 例老年患者进行了分析。
老年 NSTEMI 患者比例为 17.5%。其中 24%接受了有创治疗。有创组的院内并发症（卒中、再梗死和死亡）明显较少，但大出血除外，有创组的大出血发生率几乎高出三倍（2.9%比 1.1%，p<0.0001）。有创组 24 个月死亡率较低（29.4%比 50.4%，p<0.0001），且通过倾向评分匹配患者后仍如此（31.1%比 40.9%，p<0.0001）。2003 年至 2009 年间，噻吩吡啶类、β受体阻滞剂和他汀类药物的使用率显著上升。有创策略的应用频率显著增加，从 2003 年的 10%增加到 2009 年的 50%以上。主要出血的发生率增加了一倍，但 24 个月死亡率多年来呈显著下降趋势。
NSTEMI 的老年患者从治疗指南推荐的有创策略和现代药物治疗中显著获益。然而，这种方法与主要出血发生率的增加有关。
