Department of Emergency Medicine, Singapore General Hospital, Singapore.
National Registry of Diseases Office, Health Promotion Board, Singapore.
Emerg Med J. 2018 May;35(5):289-296. doi: 10.1136/emermed-2017-206754. Epub 2018 Mar 15.
With an ageing population, there is a need to understand the relative risk/benefit of interventions for elderly ST segment elevation myocardial infarction (STEMI) patients. The primary aim of this study was to compare epidemiology, treatments and outcomes between young and elderly STEMI patients. Our secondary aim was to determine the cut-off age when the benefits of primary percutaneous coronary intervention (PCI) were less pronounced.
Data were collected by the Singapore Myocardial Infarction Registry. Patients were categorised into young (age <65 years) and elderly STEMI (age ≥65 years) patients.
We analysed 14 006 STEMI cases collected between January 2007 and December 2014; 33.9% were elderly STEMI patients. Elderly STEMI patients had longer median door to balloon (73 vs 64 min, P<0.001) time and were less likely to receive PCI (proportion difference=-23.6%, 95% CI -25.3 to -22.0). In the absence of PCI, elderly STEMI patients had a higher mortality within 30 days (elderly: HR 1.65, 95% CI 1.36 to 1.99, P<0.001; young: HR 1.10, 95% CI 0.79 to 1.54, P=0.573) and 1 year (elderly: HR 1.83, 95% CI 1.57 to 2.14, P<0.001; young: HR 1.41, 95% CI 1.09 to 1.83, P=0.009) of admission. The 1 year survival benefit of PCI started to decline after the age of 65 years.
Elderly STEMI patients were less likely to receive PCI and had longer door to balloon times. Survival benefit of PCI decreased after the age of 65 years, with the decline most evident from age 85 years onwards. The risks of PCI need to be weighed carefully against its benefits, especially in very elderly patients.
随着人口老龄化，需要了解干预措施对老年 ST 段抬高型心肌梗死（STEMI）患者的相对风险/获益。本研究的主要目的是比较年轻和老年 STEMI 患者的流行病学、治疗和结局。我们的次要目的是确定经皮冠状动脉介入治疗（PCI）获益不明显的年龄切点。
数据由新加坡心肌梗死登记处收集。患者分为年轻（年龄＜65 岁）和老年 STEMI（年龄≥65 岁）患者。
我们分析了 2007 年 1 月至 2014 年 12 月期间收集的 14006 例 STEMI 病例；33.9%为老年 STEMI 患者。老年 STEMI 患者门球时间中位数更长（73 分钟 vs 64 分钟，P＜0.001），且更不可能接受 PCI（比例差异=-23.6%，95%CI -25.3 至 -22.0）。在未行 PCI 的情况下，老年 STEMI 患者 30 天内死亡率更高（老年：HR 1.65，95%CI 1.36 至 1.99，P＜0.001；年轻：HR 1.10，95%CI 0.79 至 1.54，P=0.573）和 1 年（老年：HR 1.83，95%CI 1.57 至 2.14，P＜0.001；年轻：HR 1.41，95%CI 1.09 至 1.83，P=0.009）内死亡率更高。PCI 的 1 年生存获益在 65 岁后开始下降。
老年 STEMI 患者更不可能接受 PCI，且门球时间更长。PCI 的生存获益在 65 岁后下降，从 85 岁以后下降更为明显。需要仔细权衡 PCI 的风险与获益，尤其是在非常高龄的患者中。
