2005年至2014年老年非ST段抬高型心肌梗死患者常规侵入性策略的结果：来自PL-ACS注册研究的结果

Outcomes of a routine invasive strategy in elderly patients with non-ST-segment elevation myocardial infarction from 2005 to 2014: results from the PL-ACS registry.

作者信息

Piątek Łukasz, Wilczek Krzysztof, Janion-Sadowska Agnieszka, Gierlotka Marek, Gąsior Mariusz, Sadowski Marcin

机构信息

The Faculty of Medicine and Health Sciences, The Jan Kochanowski University.

2nd Department of Cardiology.

出版信息

Coron Artery Dis. 2019 Aug;30(5):326-331. doi: 10.1097/MCA.0000000000000708.

DOI:10.1097/MCA.0000000000000708

PMID:30724817

Abstract

BACKGROUND

Elderly patients (≥75 years old) with non-ST-segment elevation myocardial infarction (NSTEMI) represent a large subgroup of all cases. They are rarely included in randomized trials because of comorbidities and concerns about complications. Furthermore, invasive treatments are used less frequently in this patient group. The aim of this study was to analyze trends in invasive procedures and outcomes in elderly patients with NSTEMI from 2005 to 2014.

PATIENTS AND METHODS

We analyzed 68 978 elderly patients with NSTEMI enrolled in the prospective, nationwide Polish Registry of Acute Coronary Syndromes from 2005 to 2014.

RESULTS

Elderly patients accounted for 34.9% of all patients with NSTEMI. There was an increase in the rate of coronary angiography from 19.1% in 2005-2007 to 83.5% in 2012-2014 among women (P<0.05) and from 26.0 to 87.5% among men (P<0.05). Simultaneously, there was an increase in percutaneous coronary intervention usage from 12.9% in 2005-2007 to 56.3% in 2012-2014 among women (P<0.05) and from 17.6 to 60.5% among men (P<0.05). On comparing the periods of 2005-2007 and 2012-2014, in-hospital mortality decreased considerably from 9.6 to 5.3% among women (P<0.05) and from 9.1 to 4.7% among men (P<0.05). In the same time period, the 12-month mortality ratio decreased: from 30.5 to 22.0% among women (P<0.05) and from 32.0 to 22.8% among men (P<0.05). In multivariate analysis, age was one of the most important factors associated with poorer outcome. With each increased decade of life, the outcomes worsened - the relative risk of mortality was 1.63 [95% confidence interval (CI): 1.59-1.68] for the in-hospital prognosis and 1.57 (95% CI: 1.55-1.59) for the 12-month prognosis. Invasive treatment strategy was the strongest factor associated with improved outcome, with a relative risk of 0.31 (95% CI: 0.29-0.33) for in-hospital mortality and 0.51 (95% CI: 0.49-0.52) for 12-month mortality, respectively.

CONCLUSION

Patients with NSTEMI benefit considerably from invasive procedures independent of age. In-hospital as well as 12-month outcomes in elderly patients improved markedly in the last decade as a result of the wide implementation of an invasive treatment strategy.

摘要

背景

老年患者（≥75岁）的非ST段抬高型心肌梗死（NSTEMI）是所有病例中的一个大的亚组。由于合并症和对并发症的担忧，他们很少被纳入随机试验。此外，侵入性治疗在该患者群体中的使用频率较低。本研究的目的是分析2005年至2014年老年NSTEMI患者侵入性手术的趋势和结果。

患者和方法

我们分析了2005年至2014年纳入前瞻性全国波兰急性冠状动脉综合征登记处的68978例老年NSTEMI患者。

结果

老年患者占所有NSTEMI患者的34.9%。女性冠状动脉造影率从2005 - 2007年的19.1%增加到2012 - 2014年的83.5%（P<0.05），男性从26.0%增加到87.5%（P<0.05）。同时，女性经皮冠状动脉介入治疗的使用率从2005 - 2007年的12.9%增加到2012 - 2014年的56.3%（P<0.05），男性从17.6%增加到60.5%（P<0.05）。比较2005 - 2007年和2012 - 2014年，女性住院死亡率从9.6%大幅降至5.3%（P<0.05），男性从9.1%降至4.7%（P<0.05）。在同一时期，12个月死亡率也有所下降：女性从30.5%降至22.0%（P<0.05），男性从32.0%降至22.8%（P<0.05）。在多变量分析中，年龄是与较差结果相关的最重要因素之一。每增加一个十岁年龄段，结果就会恶化——住院预后的死亡相对风险为1.63[95%置信区间（CI）：1.59 - 1.68]，12个月预后的死亡相对风险为1.57（95%CI：1.55 - 1.59）。侵入性治疗策略是与改善结果相关的最强因素，住院死亡率的相对风险分别为0.31（95%CI：0.29 - 0.33），12个月死亡率的相对风险为0.51（95%CI：0.49 - 0.52）。