Al-Saif Shukri M, Alhabib Khalid F, Ullah Anhar, Hersi Ahmed, Alfaleh Husam, Alnemer Khalid, Tarabin Amir, Abuosa Ahmed, Kashour Tarek, Al-Murayeh Mushabab
Saud AlBabtain Cardiac Center, Dammam.
J Saudi Heart Assoc. 2012 Jan;24(1):9-16. doi: 10.1016/j.jsha.2011.08.001. Epub 2011 Oct 19.
To characterize risk profile of acute coronary syndrome (ACS) patients in different age groups and compare management provided to in-hospital outcome.
Prospective multi-hospital registry.
Seventeen secondary and tertiary care hospitals in Saudi Arabia.
Five thousand and fifty-five patients with ACS. They were divided into four groups: ⩽40 years, 41-55 years, 56-70 years and ⩾70 years.
prevalence, utilization and mortality.
Ninety-four percent of patients <40 years compared to 68% of patients >70 years were men. Diabetes was present in 70% of patients aged 56-70 years. Smoking was present in 66% of those <40 years compared to 7% of patients >70 years. Fifty-three percent of the patients >70 years and 25% of those <40 years had history of ischemic heart disease. Sixty percent of patients <40 years presented with ST elevation myocardial infarction (STEMI) while non-ST elevation myocardial infarction was the presentation in 49% of patients >70 years. Thirty-four percent of patients >70 years compared to 10% of patients <40 years presented >12 h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70 years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56 years compared to 11% in patients <40 years. Mortality was 7% in patients >70 years compared to 1.6-3% in patients <70 years. For all comparisons (p < 0.001).
Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention program as well as a systematic improvement in the care for patients with ACS including a system of care for STEMI patients. For older patients there is a need to identify medical as well as social factors that influence the therapeutic management plans.
描述不同年龄组急性冠状动脉综合征（ACS）患者的风险特征，并比较给予的治疗措施对院内结局的影响。
前瞻性多医院注册研究。
沙特阿拉伯的17家二级和三级护理医院。
5055例ACS患者。他们被分为四组：≤40岁、41 - 55岁、56 - 70岁和≥70岁。
患病率、治疗利用率和死亡率。
＜40岁的患者中94%为男性，而＞70岁的患者中这一比例为68%。56 - 70岁的患者中70%患有糖尿病。＜40岁的患者中66%有吸烟史，而＞70岁的患者中这一比例为7%。＞70岁的患者中有53%有缺血性心脏病史，＜40岁的患者中有25%有该病史。＜40岁的患者中有60%表现为ST段抬高型心肌梗死（STEMI），而＞70岁的患者中有49%表现为非ST段抬高型心肌梗死。＞70岁的患者中有34%在症状发作12小时后出现STEMI，而＜40岁的患者中这一比例为10%。＞70岁的患者中有54%接受了冠状动脉造影，而＜70岁的患者中这一比例为64% - 71%。＞70岁的患者中有24%接受了经皮冠状动脉介入治疗，而＜70岁的患者中这一比例为34% - 40%。＞56岁的STEMI患者再灌注不足率为16% - 18%，而＜40岁的患者中这一比例为11%。＞70岁的患者死亡率为7%，而＜70岁的患者死亡率为1.6% - 3%（所有比较，p＜0.001）。
年轻和老年ACS患者有独特的危险因素且表现不同。老年患者院内死亡率较高，因为他们接受的治疗不够积极。迫切需要一项全国性的预防计划，以及对ACS患者护理的系统性改善，包括针对STEMI患者的护理体系。对于老年患者，需要识别影响治疗管理计划的医学和社会因素。
