Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Am Heart J. 2014 May;167(5):666-73. doi: 10.1016/j.ahj.2014.01.013. Epub 2014 Feb 26.
Elderly patients constitute a growing part of the population presenting with ST-elevation myocardial infarction (STEMI). The use of primary percutaneous coronary intervention (PCI) in this high-risk population remains poorly investigated.
Using the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), we identified consecutive patients with STEMI 80 years or older undergoing primary PCI during a 10-year period. Temporal trends in care and 1-year prognosis were investigated, and long-term outcome was compared with a reference group of patients with STEMI aged 70 to 79 years. Relative survival was calculated by dividing the observed survival rate with the expected survival rate of the general population. Adjusted end points were calculated using Cox regression.
In total, 4,876 elderly patients with STEMI were included. During the study period, average age and presence of comorbidity increased, as well as the use of antithrombotic therapy. Procedural success remained constant. One-year mortality was exclusively reduced between the most recent vs the earliest cohort, whereas the risk of reinfarction, heart failure, stroke, and bleeding remained similar. The risk of death was higher for elderly patients early after PCI, after which the prognosis was slightly better compared with the general population. Long-term risk of adverse events increased markedly with age.
The prognosis of patients older than 80 years treated with primary PCI for STEMI was relatively unchanged during the 10-year inclusion period, despite changes in patient characteristics and treatment. Advanced age increased the risk of adverse events, but survivors of the early phase after PCI had a slightly improved prognosis compared with the general population.
老年患者在患有 ST 段抬高型心肌梗死（STEMI）的人群中所占比例不断增加。在这一高危人群中应用直接经皮冠状动脉介入治疗（PCI）的情况仍研究不足。
利用瑞典冠状动脉血管造影及血管成形术登记处（SCAAR），我们确定了在 10 年期间接受直接 PCI 治疗的年龄 80 岁及以上的连续 STEMI 患者。研究了治疗的时间趋势和 1 年预后，并将长期结果与年龄为 70 至 79 岁的 STEMI 患者的参考组进行比较。相对生存率通过将观察生存率除以一般人群的预期生存率来计算。使用 Cox 回归计算调整后的终点。
共纳入 4876 例老年 STEMI 患者。在研究期间，平均年龄和合并症的存在增加，抗血栓治疗的应用也增加了。手术成功率保持不变。与最近的队列相比，1 年死亡率仅在最早的队列中降低，而再梗死、心力衰竭、卒中和出血的风险保持相似。老年患者 PCI 后早期死亡风险较高，此后其预后略优于一般人群。随着年龄的增长，不良事件的长期风险显著增加。
在 10 年纳入期间，直接 PCI 治疗 STEMI 的 80 岁以上患者的预后相对保持不变，尽管患者特征和治疗发生了变化。高龄增加了不良事件的风险，但 PCI 早期存活者的预后略优于一般人群。
