Zhou Shan, Chen Jie, Xu Ru-Yi, Wu Hai-Yun
Chinese Navy General Hospital, Fucheng, Beijing, People's Republic of China.
Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China.
Patient Prefer Adherence. 2014 Feb 17;8:257-62. doi: 10.2147/PPA.S57776. eCollection 2014.
Rapid reperfusion therapies (RT), particularly percutaneous coronary intervention (PCI), improve short- and long-term outcomes in patients with ST segment elevation myocardial infarction (STEMI). However, a substantial proportion of patients with STEMI, especially older patients, refuse or do not undergo PCI. Our study aims to identify factors associated with the use of PCI in elderly Chinese patients with their first STEMI.
Elderly (aged 65 years of age or over) patients with STEMI were enrolled between March 2010 and August 2013 at two hospitals in Beijing. Patients with previous myocardial infarction and those with contraindications to reperfusion were excluded. A standardized questionnaire including onset time and severity of symptoms, history of angina pectoris, comorbid illnesses, functional status, family income, health insurance, education, patients' trust in treating physicians, and whether patient was acquainted with a cardiologist was used to collect data from patients or their family.
Five hundred and sixty-eight patients were enrolled. PCI was accepted by 432 (76%) and refused by 136 (24%). Multivariate analysis showed that older age (>75 years; odds ratio [OR], 0.57; 95% confidence interval [CI], 0.23-0.78), self-rated mild symptoms (OR, 0.12; 95% CI, 0.06-0.21), lower degree of trust in treating physician (<6 in a 10 point scale; [OR, 0.14; 95% CI, 0.09-0.28]), and not being acquainted with a cardiologist (OR, 0.28; 95% CI, 0.07-0.42) were associated with refusal of PCI.
PCI was refused by almost one quarter of eligible elderly Chinese patients with a first STEMI. Age, symptom severity, and trust in physician were independent factors associated with the use of PCI in these patients.
快速再灌注治疗（RT），尤其是经皮冠状动脉介入治疗（PCI），可改善ST段抬高型心肌梗死（STEMI）患者的短期和长期预后。然而，相当一部分STEMI患者，尤其是老年患者，拒绝或未接受PCI治疗。我们的研究旨在确定中国老年首次发生STEMI患者使用PCI的相关因素。
2010年3月至2013年8月期间，在北京的两家医院纳入了年龄在65岁及以上的STEMI患者。排除既往有心肌梗死病史和有再灌注禁忌证的患者。使用标准化问卷收集患者或其家属的数据，问卷内容包括症状发作时间和严重程度、心绞痛病史、合并疾病、功能状态、家庭收入、医疗保险、教育程度、患者对治疗医生的信任度以及患者是否认识心脏病专家。
共纳入568例患者。432例（76%）接受了PCI治疗，136例（24%）拒绝了PCI治疗。多因素分析显示，年龄较大（>75岁；比值比[OR]，0.57；95%置信区间[CI]，0.23 - 0.78）、自评症状较轻（OR，0.12；95%CI，0.06 - 0.21）、对治疗医生的信任度较低（10分制中<6分；[OR，0.14；95%CI，0.09 - 0.28]）以及不认识心脏病专家（OR，0.28；95%CI，0.07 - 0.42）与拒绝PCI治疗相关。
近四分之一符合条件的中国老年首次发生STEMI患者拒绝了PCI治疗。年龄、症状严重程度和对医生的信任度是这些患者使用PCI的独立相关因素。
