Sujino Yasumori, Tanno Jun, Nakano Shintaro, Funada Shuhei, Hosoi Yoshie, Senbonmatsu Takaaki, Nishimura Shigeyuki
Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
J Cardiol. 2015 Sep;66(3):263-8. doi: 10.1016/j.jjcc.2014.12.001. Epub 2014 Dec 26.
The optimal treatment strategies for acute ST-elevation myocardial infarction (STEMI) in older patients are unclear because of the high risk of mortality in this population. Hypoalbuminemia, frailty, and body mass index (BMI) have been reported to worsen the prognosis of some older patients with cardiovascular disease, but the specific impact of these factors on the prognosis after STEMI is poorly understood. The aim of this study was to investigate the impact of these factors on early outcomes in patients aged ≥85 years with acute STEMI.
Sixty-two consecutive eligible patients aged ≥85 years (mean age, 88.1±2.5 years; age range, 85-94 years; female, 41.9%; primary percutaneous coronary intervention, 67.7%) who were admitted to our hospital with STEMI were retrospectively reviewed. Baseline patient characteristics, echocardiographic, electrocardiographic, and laboratory findings, and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) score were assessed. The primary endpoint was in-hospital mortality and the secondary endpoint was failure of discharge to home. Independent baseline variables with a p-value of <0.15 in the univariate analyses were included in the multivariate analyses.
Multivariate analysis identified a higher baseline serum troponin I level [p=0.046; odds ratio (OR): 1.02], lower baseline albumin level (p=0.035, OR: 0.16), and CSHA-CFS score ≥6 (p=0.028, OR: 6.38) as independent predictors of in-hospital mortality. Lower BMI (p<0.001, OR: 0.49) and CSHA-CFS frailty score ≥6 (p=0.002, OR: 16.69) were identified as independent predictors of failure of discharge to home.
These findings indicate that the serum albumin level, CSHA-CFS score, and BMI, in addition to serum troponin I level, have an impact on the early prognosis of older patients with STEMI.
老年急性ST段抬高型心肌梗死（STEMI）患者的最佳治疗策略尚不清楚，因为该人群死亡率高。据报道，低蛋白血症、虚弱和体重指数（BMI）会使一些老年心血管疾病患者的预后恶化，但这些因素对STEMI后预后的具体影响尚不清楚。本研究的目的是调查这些因素对≥85岁急性STEMI患者早期结局的影响。
回顾性分析我院收治的62例连续符合条件的≥85岁STEMI患者（平均年龄88.1±2.5岁；年龄范围85-94岁；女性占41.9%；接受直接经皮冠状动脉介入治疗的占67.7%）。评估患者的基线特征、超声心动图、心电图和实验室检查结果，以及加拿大健康与老龄化临床虚弱量表（CSHA-CFS）评分。主要终点是住院死亡率，次要终点是未能出院回家。单因素分析中p值<0.15的独立基线变量纳入多因素分析。
多因素分析确定较高的基线血清肌钙蛋白I水平[p=0.046；比值比（OR）：1.02]、较低的基线白蛋白水平（p=0.035，OR：0.16）和CSHA-CFS评分≥6（p=0.028，OR：6.38）是住院死亡率的独立预测因素。较低的BMI（p<0.001，OR：0.49）和CSHA-CFS虚弱评分≥6（p=0.002，OR：16.69）是未能出院回家的独立预测因素。
这些发现表明，除血清肌钙蛋白I水平外，血清白蛋白水平、CSHA-CFS评分和BMI对老年STEMI患者的早期预后有影响。
