第二代药物洗脱支架用于老年急性冠状动脉综合征患者：全人群注册研究的住院期间及12个月随访
Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry.
作者信息
Wańha Wojciech, Kawecki Damian, Roleder Tomasz, Morawiec Beata, Gładysz Sylwia, Kowalówka Adam, Jadczyk Tomasz, Adamus Barbara, Pawłowski Tomasz, Smolka Grzegorz, Kaźmierski Maciej, Ochała Andrzej, Nowalany-Kozielska Ewa, Wojakowski Wojciech
机构信息
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Second Division of Cardiology, Medical University of Silesia, Zabrze, Poland.
出版信息
Aging Clin Exp Res. 2017 Oct;29(5):885-893. doi: 10.1007/s40520-016-0649-8. Epub 2016 Nov 10.
BACKGROUND
Katowice-Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES).
METHODS
The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up.
RESULTS
Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49-4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19-0.82); p = 0.012] in the elderly.
CONCLUSION
This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.
背景
卡托维兹-扎布热登记处提供的数据可用于评估使用第一代（DES-I）或第二代（DES-II）药物洗脱支架（DES）治疗的老年患者（≥70岁）经皮冠状动脉介入治疗的临床结果。
方法
该登记处包含1916例使用DES-I或DES-II支架进行冠状动脉介入治疗患者的数据。在我们的研究中，我们将年龄≥70岁的患者定义为老年人。我们在12个月的随访中评估了任何主要不良心脑血管事件（MACCE）。
结果
冠状动脉造影显示该老年患者群体中多支冠状动脉疾病的发生率较高。急性和亚急性支架血栓形成无差异（0.4%对0.6%，p = 0.760；0.4%对0.4%；p = 0.712）。老年患者发生需要输血的院内出血并发症更多（2.0%对0.9%；p = 0.003）。在住院期间，该老年患者中复苏后心脏骤停（2.0%对0.9%；p = 0.084）的观察频率更高。两组间院内复合MACCE发生率无统计学差异（1.4%对1.1%；p = 0.567）。12个月随访数据显示，老年人死亡率更高（7.1%对1.8%；p < 0.001），靶病变血管重建（TVR）无差异（7.2%对9.9%，p = 0.075），心肌梗死（MI）无差异（6.0%对4.8%，p = 0.300），中风无差异（0.8%对0.6%，p = 0.600），复合MACCE无差异（15.0%对13.4%，p = 0.324）。70岁及以上年龄是死亡的独立预测因素[HR = 2.55（95%CI 1.49 - 4.37）；p < 0.001]。使用DES-II降低了老年人发生MI的风险[HR = 0.40（95%CI 0.19 - 0.82）；p = 0.012]。
结论
该老年患者群体发生需要输血的院内出血并发症风险增加，且在12个月随访时死亡风险更高。使用新一代DES降低了老年人群发生MI的风险。
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