与年轻急性心肌梗死患者相比，老年患者无创治疗及28天病死率的预测因素：一项来自莫妮卡/科拉心肌梗死登记处的观察性研究
Predictors of non-invasive therapy and 28-day-case fatality in elderly compared to younger patients with acute myocardial infarction: an observational study from the MONICA/KORA Myocardial Infarction Registry.
作者信息
Amann Ute, Kirchberger Inge, Heier Margit, Thilo Christian, Kuch Bernhard, Peters Annette, Meisinger Christa
机构信息
MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
出版信息
BMC Cardiovasc Disord. 2016 Jul 13;16:151. doi: 10.1186/s12872-016-0322-3.
BACKGROUND
A substantial proportion of patients with acute myocardial infarction (AMI) did not receive invasive therapy, defined as percutaneous coronary intervention and/or coronary artery bypass grafting. Aims of this study were to evaluate predictors of non-invasive therapy in elderly compared to younger AMI patients and to assess the association between invasive therapy and 28-day-case fatality.
METHODS
From the German population-based registry, 3475 persons, consecutively hospitalized with an AMI between 2009 and 2012 were included. Data were collected by standardized interviews and chart review. All-cause mortality was assessed on a regular basis. Multivariable logistic regression analyses were conducted.
RESULTS
The sample consisted of 1329 patients aged 28-65 years (age category [AC] 1), 1083 aged 65-74 years (AC 2), and 1063 aged 75-84 years (AC 3). The proportion of patients receiving non-invasive therapy was 10.7, 17.7, and 35.8 % in AC 1, 2, and 3, respectively. Predictors of non-invasive therapy in all ACs were non-ST segment elevation MI, bundle branch block, reduced left ventricular ejection fraction, prior stroke, absence of hyperlipidemia, and low creatine kinase. Elderly women (≥65 years) were less likely to receive invasive therapy. Stratifying the models by type of AMI revealed fewer predictors in patients with ST segment elevation MI. Regarding 28-day-case fatality, strong inverse relations with invasive therapy were seen in all AC: odds ratio of 0.35 (95 % confidence interval [CI] 0.15-0.84), 0.45 (95 % CI 0.22-0.92), and 0.39 (95 % CI 0.24-0.63) in AC 1, 2 and 3, respectively.
CONCLUSION
In today's real-life patient care we found that predictors of non-invasive therapy were predominantly the same in all age groups, but differed particularly by type of AMI. Further research is necessary to investigate the real reasons for non-invasive therapy, especially among elderly women. Moreover, we confirmed that receiving invasive therapy was inversely associated with 28-day-case fatality independent of age.
背景
相当一部分急性心肌梗死（AMI）患者未接受侵入性治疗，侵入性治疗定义为经皮冠状动脉介入治疗和/或冠状动脉旁路移植术。本研究的目的是评估老年AMI患者与年轻AMI患者相比非侵入性治疗的预测因素，并评估侵入性治疗与28天病例死亡率之间的关联。
方法
从德国基于人群的登记处纳入了2009年至2012年间连续住院治疗AMI的3475人。通过标准化访谈和病历审查收集数据。定期评估全因死亡率。进行多变量逻辑回归分析。
结果
样本包括1329名年龄在28 - 65岁的患者（年龄组[AC]1），1083名年龄在65 - 74岁的患者（AC2），以及1063名年龄在75 - 84岁的患者（AC3）。AC1、AC2和AC3中接受非侵入性治疗的患者比例分别为10.7%、17.7%和35.8%。所有年龄组中非侵入性治疗的预测因素为非ST段抬高型心肌梗死、束支传导阻滞、左心室射血分数降低、既往中风、无高脂血症以及肌酸激酶水平低。老年女性（≥65岁）接受侵入性治疗的可能性较小。按AMI类型对模型进行分层显示，ST段抬高型心肌梗死患者的预测因素较少。关于28天病例死亡率，在所有年龄组中均观察到与侵入性治疗存在强烈的负相关：AC1、AC2和AC3中的比值比分别为0.35（95%置信区间[CI]0.15 - 0.84）、0.45（95%CI 0.22 - 0.92）和0.39（95%CI 0.24 - 0.63）。
结论
在当今的实际患者护理中，我们发现所有年龄组中非侵入性治疗的预测因素主要相同，但因AMI类型而异。有必要进一步研究非侵入性治疗的真正原因，尤其是老年女性中的原因。此外，我们证实接受侵入性治疗与28天病例死亡率呈负相关，且与年龄无关。
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