Sim Wei Liang, Mutha Vivek, Ul-Haq Muhammad Asrar, Sasongko Victoria, Van-Gaal William
Wei Liang Sim, Victoria Sasongko, William Van-Gaal, Department of Cardiology, Northern Hospital, Epping, Victoria 3076, Australia.
World J Cardiol. 2017 May 26;9(5):437-441. doi: 10.4330/wjc.v9.i5.437.
To investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction (STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention (PCI) compared to those managed conservatively.
We performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included. The subsequent non-octogenarian patient who presented with a STEMI following the octogenarian patient was assigned to the control group in a 1:1 manner. The outcomes measured were peri-procedural cardiac arrest, death on table, cerebrovascular accidents (CVA), in-hospital and 30-d mortality.
A total of 146 patients were analyzed. The octogenarian group had a higher percentage of females, higher overall comorbidities, higher Charlson Comorbidity Index score, worse renal function and were more likely to require residential care and home help. The octogenarian group were also less likely to have PCI attempted and had a longer symptom onset to PCI time. Mortality rate was high amongst octogenarians who presented with STEMI. However, those managed conservatively had a higher in-hospital and 30-d mortality rate.
Octogenarians who presented with STEMI that were managed conservatively had a higher mortality rate compared to those who had primary PCI. Therefore, we propose that revascularization may be beneficial to patients in this age group.
研究与非八旬老人相比，出现ST段抬高型心肌梗死（STEMI）的八旬老人的特征和预后，并研究接受直接经皮冠状动脉介入治疗（PCI）的八旬老人与接受保守治疗的八旬老人的预后情况。
我们进行了一项单中心回顾性病例对照研究。纳入了2007年至2012年间在一家三级转诊医院出现STEMI的所有八旬老人。以1:1的方式将在八旬老人患者之后出现STEMI的非八旬老人患者分配到对照组。测量的结局指标包括围手术期心脏骤停、术中死亡、脑血管意外（CVA）、住院期间及30天死亡率。
共分析了146例患者。八旬老人组女性比例更高，总体合并症更多，Charlson合并症指数评分更高，肾功能更差，更有可能需要住院护理和家庭帮助。八旬老人组尝试进行PCI的可能性也更低，症状发作至PCI的时间更长。出现STEMI的八旬老人死亡率较高。然而，接受保守治疗的患者住院期间及30天死亡率更高。
与接受直接PCI的患者相比，出现STEMI且接受保守治疗的八旬老人死亡率更高。因此，我们建议血运重建可能对该年龄组患者有益。
