Nagata Takuya, Hyakuna Yohei, Miyata Kenji, Mohri Masahiro
Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan.
Department of Cardiology, Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan.
Int J Cardiol. 2017 Aug 1;240:49-54. doi: 10.1016/j.ijcard.2017.03.118. Epub 2017 Mar 30.
An early invasive strategy for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has been recommended. However, patients at greater risk including the elderly are more often managed conservatively. We aimed to elucidate contemporary practice and outcomes of patients with NSTE-ACS who were referred to our hospital located in Kitakyushu City, one of the most aging metropolises in Japan.
A total of 270 consecutive NSTE-ACS patients hospitalized between January 2012 and December 2014 were retrospectively studied.
Median [interquartile range] age was 73 [64, 80]years. Coronary angiography was performed in 264 (98%) patients. Importantly, 75% and 89% underwent angiography within 24h and 72h after admission, respectively. Revascularization was done in 124 (79%). The all-cause, in-hospital mortality was 3.7% and was higher in patients aged ≥80years (8.5% vs. 2.0% in those aged <80years, p<0.0001). No patient developed major bleeding or stroke during hospitalization. Killip class IV at presentation (odds ratio [OR] 8.77, 95% confidence intervals [CI] 1.64-47.6) and left main trunk disease (OR 7.58, 95% CI 1.28-45.5) were independently associated with in-hospital death. These two variables and a high (≥140) GRACE score were associated with a higher 1-year mortality by Kaplan-Meier survival analysis (p<0.0001).
An early invasive strategy was safely done in an elderly cohort of Japanese patients with NSTE-ACS. In addition to early invasive approach, a further therapeutic strategy, most probably targeting a shock status, is needed to improve both short- and long-term survival.
对于非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者，推荐采用早期侵入性策略。然而，包括老年人在内的高危患者更常采用保守治疗。我们旨在阐明转诊至位于日本老龄化最严重的大都市之一北九州市的我院的NSTE-ACS患者的当代治疗实践及预后情况。
对2012年1月至2014年12月期间连续住院的270例NSTE-ACS患者进行回顾性研究。
年龄中位数[四分位间距]为73[64, 80]岁。264例（98%）患者接受了冠状动脉造影。重要的是，分别有75%和89%的患者在入院后24小时和72小时内接受了造影。124例（79%）患者进行了血运重建。全因住院死亡率为3.7%，≥80岁患者的死亡率更高（8.5%对<80岁患者的2.0%，p<0.0001）。住院期间无患者发生大出血或中风。就诊时Killip分级为IV级（比值比[OR] 8.77，95%置信区间[CI] 1.64 - 47.6）和左主干病变（OR 7.58，95% CI 1.28 - 45.5）与住院死亡独立相关。通过Kaplan-Meier生存分析，这两个变量以及高（≥140）GRACE评分与1年死亡率较高相关（p<0.0001）。
在日本老年NSTE-ACS患者队列中安全地实施了早期侵入性策略。除了早期侵入性方法外，还需要进一步的治疗策略，很可能针对休克状态，以改善短期和长期生存率。
