Helft Gérard, Georges Jean-Louis, Mouranche Xavier, Loyeau Aurélie, Spaulding Christian, Caussin Christophe, Benamer Hakim, Garot Philippe, Livarek Bernard, Teiger Emmanuel, Varenne Olivier, Monségu Jacques, Mapouata Mireille, Petroni Thibaut, Hammoudi Nadjib, Lambert Yves, Dupas François, Laborne François, Lapostolle Frederic, Lefort Hugues, Juliard Jean-Michel, Letarnec Jean-Yves, Lamhaut Lionel, Lebail Gaëlle, Boche Thévy, Jouven Xavier, Bataille Sophie
Assistance Publique-Hôpitaux de Paris, Cardiology Department, Pitié-Salpétrière Hospital, Paris, France; Assistance Publique-Hôpitaux de Paris, ICAN, Pitié-Salpétrière Hospital, Paris, France; Pierre et Marie-Curie University, Paris, France.
Versailles Hospital, Cardiology Department, Le Chesnay, France.
Int J Cardiol. 2015 Aug 1;192:24-9. doi: 10.1016/j.ijcard.2015.04.227. Epub 2015 Apr 30.
Few data are available on primary percutaneous coronary intervention (pPCI) in nonagenarians. In a large prospective registry on pPCI for STEMI we compared the demographics, procedural and in-hospital outcomes between nonagenarians (age ≥ 90 years) and patients aged < 90 years.
We included 26,157 consecutive patients with pPCI in the Greater Paris Area region between 2003 and 2011. Of these, 418 (1.6%) were ≥ 90 years old. Nonagenarians (versus patients < 90 years) were more likely to be female (62.3% versus 22.5%, p < 0.0001), nonsmokers (81.6% versus 36.7%, p < 0.0001), in cardiogenic shock (Killip IV) upon admission (10.5% versus 4.8%, p < 0.001), and had significant co-morbidities. Over two-thirds of patients underwent procedures via the radial artery (61% versus 72.1%, p = 0.007). Both groups had high and similar angiographic success rates (98.1% versus 98.7%, p = 0.33). Drug-eluting stents were used less often in nonagenarians (4.4% versus 16.7%, p < 0.0001). Hospital mortality was significantly much higher in patients over 90 years old (24.9% versus 5.1%, p < 0.001) in univariate analysis. After adjustment for sex, cardiogenic shock, diabetes, triple vessel disease, drug-eluting stent use and glycoprotein IIb/IIIa inhibitors use, mortality remains higher in nonagenarian patients (OR: 4.31; 95% CI: 3.26-5.71, p < 0.0001).
In a real-world setting, we found important demographic differences in nonagenarian compared to younger patients. Despite achieving a high rate of reperfusion with pPCI using mainly radial access, similar to that achieved in younger patients, hospital mortality was higher in nonagenarians.
关于非agenarians（90岁及以上）进行直接经皮冠状动脉介入治疗（pPCI）的数据很少。在一项关于STEMI患者pPCI的大型前瞻性注册研究中，我们比较了90岁及以上患者（年龄≥90岁）与年龄<90岁患者的人口统计学特征、手术及住院结局。
我们纳入了2003年至2011年间大巴黎地区连续接受pPCI的26,157例患者。其中，418例（1.6%）年龄≥90岁。90岁及以上患者（与<90岁患者相比）更可能为女性（62.3%对22.5%，p<0.0001）、非吸烟者（81.6%对36.7%，p<0.0001）、入院时处于心源性休克（Killip IV级）（10.5%对4.8%，p<0.001），且有显著的合并症。超过三分之二的患者通过桡动脉进行手术（61%对72.1%，p = 0.007）。两组的血管造影成功率都很高且相似（98.1%对98.7%，p = 0.33）。90岁及以上患者使用药物洗脱支架的频率较低（4.4%对16.7%，p<0.0001）。单因素分析显示，90岁以上患者的医院死亡率显著更高（24.9%对5.1%，p<0.001）。在对性别、心源性休克、糖尿病、三支血管病变、药物洗脱支架使用和糖蛋白IIb/IIIa抑制剂使用进行调整后，90岁及以上患者的死亡率仍然较高（OR：4.31；95%CI：3.26 - 5.71，p<0.0001）。
在实际临床环境中，我们发现90岁及以上患者与年轻患者在人口统计学特征上存在重要差异。尽管通过主要经桡动脉途径进行pPCI实现了与年轻患者相似的高再灌注率，但90岁及以上患者的医院死亡率更高。
