Functional Area of Emergency Medicine, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden; Department of Medicine, Solna, KarolinskaInstitutet, 17171 Stockholm, Sweden.
Department of Medicine, Solna, KarolinskaInstitutet, 17171 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17171 Stockholm, Sweden.
Int J Cardiol. 2018 Sep 15;267:57-61. doi: 10.1016/j.ijcard.2018.05.078. Epub 2018 May 24.
There is a paucity of data if there is a benefit for patients above 80 years of age with non-ST-segment elevation myocardial infarction (NSTEMI) to undergo percutaneous coronary intervention (PCI).
To investigate the association between PCI or conservative treatment and outcomes in NSTEMI patients above 80 years of age.
From the SWEDEHEART register were included 13,854 patients above 80 years of age with NSTEMI during 2011-2014 in Sweden. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the association between PCI compared with conservative treatment for the outcome all-cause mortality.
In total 4158 (30%) patients underwent PCI, and 9696 (70%) were treated conservatively. The mean age was 86 (±4) years. During a mean 2.2 (±1.4) years there were 6458 (47%) deaths, where of 1078 (26%) in PCI treated, and 5380 (56%) in conservatively treated patients. Treatment with PCI compared with conservative treatment was associated with a 40% lower risk of death (adjusted HR 0.60, 95% CI 0.55-0.66). Similarly, patients in the PCI group had a 60% lower 30-day, and 51% lower 1-year all-cause mortality, respectively (adjusted HR 0.40, 95% CI 0.25-0.63, and HR, 0.49 95% CI 0.42-0.57, respectively). There were no differences in risk of bleedings (1.4% versus 1.3%).
PCI compared with conservative treatment was associated with a lower mortality in patients above 80 years of age with NSTEMI without an increased risk of bleedings. PCI may be considered as the treatment of choice for elderly with NSTEMI.
对于 80 岁以上非 ST 段抬高型心肌梗死（NSTEMI）患者，经皮冠状动脉介入治疗（PCI）是否有益，目前数据有限。
研究 80 岁以上 NSTEMI 患者接受 PCI 或保守治疗与结局的相关性。
从瑞典 SWEDEHEART 注册中心纳入 2011 年至 2014 年期间 80 岁以上 NSTEMI 患者 13854 例。采用 Cox 回归计算 PCI 与保守治疗的结局全因死亡率之间的关联的风险比（HR）及其 95%置信区间（CI）。
共 4158 例（30%）患者接受 PCI，9696 例（70%）接受保守治疗。平均年龄为 86（±4）岁。在平均 2.2（±1.4）年期间，有 6458 例（47%）死亡，其中 PCI 治疗组 1078 例（26%），保守治疗组 5380 例（56%）。与保守治疗相比，PCI 治疗与死亡风险降低 40%相关（校正 HR 0.60，95%CI 0.55-0.66）。同样，PCI 组患者 30 天和 1 年全因死亡率分别降低 60%和 51%（校正 HR 0.40，95%CI 0.25-0.63，HR 0.49，95%CI 0.42-0.57）。出血风险无差异（1.4%比 1.3%）。
与保守治疗相比，80 岁以上 NSTEMI 患者接受 PCI 治疗与死亡率降低相关，且出血风险无增加。对于 NSTEMI 老年患者，PCI 可考虑作为首选治疗方法。
