Department of Internal Medicine, Korea University, Ansan, Korea.
J Korean Med Sci. 2013 Jul;28(7):1027-33. doi: 10.3346/jkms.2013.28.7.1027. Epub 2013 Jul 3.
This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFR<60 mL/min) received either medical (n=439) or PCI (n=1,019) therapy. Primary end point was in-hospital death. Secondary end point was MACE during a 1 month and 1 yr follow-up. PCI group showed a significantly lower incidence of in-hospital death (20.0% vs 14.3%, P=0.006). Short-term and long-term MACE rates were higher in medical therapy group (31.9% vs 19.0%; 57.7% vs 31.3%, P<0.001), and this difference was mainly attributed to cardiac death (29.3% vs 17.6%; 51.9% vs 25.0%, P<0.001). MACE-free survival time after adjustment was also higher in PCI group on short-term (hazard ratio, 0.67; confidence interval, 0.45-0.98; P=0.037) and long-term follow-up (hazard ratio, 0.61, confidence interval, 0.45-0.83; P=0.002). In elderly AMI patients with renal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.
本研究旨在评估经皮冠状动脉介入治疗（PCI）对伴有肾功能障碍的老年（>75 岁）急性心肌梗死（AMI）患者短期和长期主要不良心脏事件（MACE）的影响。作为韩国 AMI 注册研究（KAMIR）的一部分，伴有 AMI 和肾功能障碍（GFR<60 mL/min）的老年患者接受了药物治疗（n=439）或 PCI 治疗（n=1,019）。主要终点为住院期间死亡。次要终点为 1 个月和 1 年随访期间的 MACE。PCI 组住院期间死亡率明显较低（20.0% vs 14.3%，P=0.006）。药物治疗组短期和长期 MACE 发生率较高（31.9% vs 19.0%；57.7% vs 31.3%，P<0.001），这种差异主要归因于心脏性死亡（29.3% vs 17.6%；51.9% vs 25.0%，P<0.001）。调整后 PCI 组短期（风险比，0.67；置信区间，0.45-0.98；P=0.037）和长期随访（风险比，0.61，置信区间，0.45-0.83；P=0.002）的 MACE 无事件生存时间也较高。在伴有肾功能障碍的老年 AMI 患者中，PCI 治疗可获得良好的住院期间和短期及长期 MACE 无事件生存。
