Atas Halil, Tigen Kursat, Ozben Beste, Kartal Fatih, Gurel Emre, Atas Dilek B, Sari İbrahim, Basaran Yelda
Marmara University School of Medicine Department of Cardiology, Istanbul, Turkey.
Clin Invest Med. 2018 Jun 30;41(2):E43-E50. doi: 10.25011/cim.v41i2.29914.
Octogenarians with acute coronary syndromes have higher mortality and morbidity due to higher prevalence of comorbidities and frailty. The aim of this study was to explore the predictors of short and long term mortality in octogenarians with ACS.
Ninety-eight consecutive octogenarians presenting with acute coronary syndrome (mean age:84±3 years, 56 male) were included. All patients underwent coronary angiography and were given optimal medical treatment. The primary end point was cardiovascular mortality in hospital and at one year.
Fifteen patients died during hospitalization and 20 patients died after discharge within the first year. ST-segment-elevation myocardial infarction and hypotension were significantly more prevalent in the in-hospital mortality group while atrial fibrillation and hyponatremia were more prevalent in the long-term mortality group. All deceased patients had significantly lower left ventricular ejection fraction and glomerular filtration rate. Cox analysis revealed ST-segment-elevation myocardial infarction, hypotension and left ventricular ejection fraction as independent predictors of in-hospital mortality while hyponatremia, atrial fibrillation and renal dysfunction as independent predictors of long term mortality.
It would be reasonable to pay further attention to octogenarians with acute coronary syndrome if they are presenting with ST-segment-elevation myocardial infarction, and have hypotension, impaired left ventricular function, hyponatremia, atrial fibrillation or renal dysfunction, which are associated with increased mortality.
由于合并症和身体虚弱的患病率较高，患有急性冠脉综合征的八旬老人死亡率和发病率更高。本研究的目的是探讨患有急性冠脉综合征的八旬老人短期和长期死亡率的预测因素。
纳入98例连续就诊的患有急性冠脉综合征的八旬老人（平均年龄：84±3岁，男性56例）。所有患者均接受了冠状动脉造影，并接受了最佳药物治疗。主要终点是住院期间和一年时的心血管死亡率。
15例患者在住院期间死亡，20例患者在出院后第一年内死亡。ST段抬高型心肌梗死和低血压在院内死亡组中更为常见，而房颤和低钠血症在长期死亡组中更为常见。所有死亡患者的左心室射血分数和肾小球滤过率均显著降低。Cox分析显示，ST段抬高型心肌梗死、低血压和左心室射血分数是院内死亡的独立预测因素，而低钠血症、房颤和肾功能不全是长期死亡的独立预测因素。
对于患有急性冠脉综合征且伴有ST段抬高型心肌梗死、低血压、左心室功能受损、低钠血症、房颤或肾功能不全的八旬老人，应进一步关注，因为这些情况与死亡率增加有关。
