急性冠状动脉综合征患者的年龄与临床结局
Age and clinical outcomes in patients presenting with acute coronary syndromes.
作者信息
Ahmed Emad, Alhabib Khalid F, El-Menyar Ayman, Asaad Nidal, Sulaiman Kadhim, Hersi Ahmad, Almahmeed Wael, Alsheikh-Ali Alawi A, Amin Haitham, Al-Motarreb Ahmed, Al Saif Shukri, Singh Rajvir, Al-Lawati Jawad, Al Suwaidi Jassim
机构信息
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
出版信息
J Cardiovasc Dis Res. 2013 Jun;4(2):134-9. doi: 10.1016/j.jcdr.2012.08.005. Epub 2013 Jun 21.
CONTEXT
Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients.
AIMS
To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS).
METHODS AND MATERIAL
Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: ≤50 years, 51-70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months.
STATISTICAL ANALYSIS USED
One-way ANOVA test for continuous variables, Pearson chi-square (X (2)) test for categorical variables and multivariate logistic regression analysis for predictors were performed.
RESULTS
Among 7930 consecutive ACS patients; 2755 (35%) were ≤50 years, 4110 (52%) were 51-70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients ≤50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03-1.60), heart failure (OR 2.8; 95% CI 2.17-3.52) and major bleeding (OR 4.02; 95% CI 1.37-11.77) and in-hospital mortality (age 51-70: OR 2.67; 95% CI 1.86-3.85, and age >70: OR 4.71; 95% CI 3.11-7.14).
CONCLUSION
Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.
背景
老年患者比年轻患者有更多的心血管危险因素和更重的缺血性疾病负担。
目的
研究年龄对急性冠状动脉综合征（ACS）患者临床表现和预后的影响。
方法和材料
收集来自第二届海湾急性冠状动脉事件注册研究（海湾RACE-2）的数据，这是一项来自六个相邻阿拉伯中东海湾国家的前瞻性多中心研究。根据年龄将患者分为3组：≤50岁、51 - 70岁和>70岁，并分析其临床特征和预后。在1个月和12个月时评估死亡率。
使用的统计分析方法
对连续变量进行单因素方差分析，对分类变量进行Pearson卡方（X²）检验，对预测因素进行多因素逻辑回归分析。
结果
在7930例连续的ACS患者中；2755例（35%）≤50岁，4110例（52%）51 - 70岁，1065例（13%）>70岁。女性比例随年龄增加而升高（≤50岁患者中为13%，>70岁患者中为31%）。危险因素模式随年龄而异；年轻患者更常肥胖、吸烟且有CAD家族史阳性，而老年患者更可能患有糖尿病、高血压和血脂异常。年龄增长与基于证据的治疗不足相关。在调整相关协变量后的多因素逻辑回归分析显示，老年是再缺血（OR 1.29；95%CI 1.03 - 1.60）、心力衰竭（OR 2.8；95%CI 2.17 - 3.52）、大出血（OR 4.02；95%CI 1.37 - 11.77）和住院死亡率（51 - 70岁：OR 2.67；95%CI 1.86 - 3.85，>70岁：OR 4.71；95%CI 3.11 - 7.14）的独立预测因素。
结论
尽管老年患者是高危人群，但他们接受基于证据治疗的可能性较小且预后较差。强烈建议老年患者遵循指南。
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