Unità di Cure Intensive Cardiologiche; ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy.
Division of Cardiology, Ospedale Manzoni, Lecco, Italy.
Am J Med. 2019 Feb;132(2):209-216. doi: 10.1016/j.amjmed.2018.10.027. Epub 2018 Nov 14.
Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far.
Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke.
Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7).
Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.
急性冠状动脉综合征（ACS）根据就诊时心电图 ST 段抬高的发现进行分类，不同的治疗策略和实践指南也有所不同。然而，目前尚未发表关于接受经皮冠状动脉介入治疗的老年 ACS 患者的临床特征和结局的比较描述。
回顾性队列研究纳入了 Elderly ACS-2 多中心随机试验中的患者。主要观察指标为心血管死亡、非心血管死亡、再梗死和卒中的总累积发生率和原因特异性危险比（cHR）。
在 1443 例年龄>75 岁的 ACS 患者中（中位年龄 80 岁，四分位间距 77-84），41%被归类为 ST 段抬高型心肌梗死（STEMI），59%为非 ST 段抬高型 ACS（NSTEACS）（48%为 NSTEMI，11%为不稳定型心绞痛）。与 NSTEACS 患者相比，STEMI 患者的基线危险因素更有利，既往心血管事件更少，冠状动脉病变程度较轻，但射血分数较低（45%比 50%，P<0.001）。中位随访 12 个月时，51 例（8.6%）STEMI 患者死亡，39 例（4.6%）NSTEACS 患者死亡。在校正性别、年龄和既往心肌梗死后，STEMI 组的心血管死亡（cHR 1.85；95%置信区间[CI]，1.02-3.36）、非心血管死亡（cHR 2.10；95% CI，1.01-4.38）和卒中（cHR 4.8；95% CI，1.7-13.7）的危险显著更高。
尽管 STEMI 患者的基线特征更有利，但与 NSTEACS 患者相比，经皮冠状动脉介入治疗后的老年 STEMI 患者的生存率更差，卒中风险更高。
