Kocayigit Ibrahim, Yaylaci Selcuk, Osken Altug, Aydın Ercan, Sahinkus Salih, Can Yusuf, Genc Ahmed Bilal, Gunduz Huseyin
Department of Cardiology, Sakarya University Education and Research Hospital, Sakarya, Turkey.
Department of Internal Medicine, Sakarya University Education and Research Hospital, Sakarya, Turkey.
Arch Med Sci Atheroscler Dis. 2019 May 27;4:e82-e88. doi: 10.5114/amsad.2019.85378. eCollection 2019.
This study aims to evaluate the effect of primary percutaneous coronary intervention (PCI) and thrombolytic therapy (TT) on the in-hospital adverse events, in-hospital and long-term mortality in patients over 65 years of age with acute ST-segment elevation myocardial infarction (STEMI).
A total of 111 retrospectively screened patients (73 males, mean age: 73.4 ±5.9 years) over 65 years of age with STEMI, who underwent TT or primary PCI, were included in the study. Patients' characteristics, in-hospital outcomes, and 6-month and 1-year mortalities were recorded.
Our study was conducted with 111 patients over 65 years of age with STEMI (73 males, 38 females). Of the patients, 66 (59.5%) were treated with thrombolytics, and 45 (40.5%) patients underwent primary PCI. Door-to-needle time was 25.9 ±7.8 min in the TT group, whereas door-to-balloon time was 84.4 ±20.0 min in the PCI group. Time from symptom onset to hospital admission was 213.6 ±158.4 min in the thrombolytic group, and 166.8 ±112.8 min in the PCI group. Rescue PCI was performed in 7 (10.6%) patients in the TT group due to lack of reperfusion. Recurrent infarction was observed in 5 (7.6%) patients in the TT group and in 2 (4.4%) patients in the PCI group. Non-haemorrhagic stroke was observed in 1 (1.5%) patient in the thrombolytic-administered group and in 4 (8.9%) patients in the PCI group. No intracranial haemorrhage was observed in any patient. Major haemorrhage was observed in 4 (6.1%) patients in the TT group and in 4 (8.9%) patients in the PCI group. Six-month and 1-year mortalities were present in 15 (22.7%) patients and 19 patients in thrombolytic group, and 8 (17.8%) and 8 (17.8%) patients in the PCI group, respectively. Binary logistic regression analysis indicated that the patient's age was the only predictor for 1-year mortality (odds ratio (OR) = 1.1, 95% confidence interval (CI): 1.019-1.188, = 0.015).
Considering the in-hospital adverse outcomes, in-hospital mortality, and 6-month mortality rates, TT and primary PCI have similar effects in STEMI patients aged 65 years and over according to the results of our study. Although 1-year mortality was higher in the TT group, it was not statistically significant.
本研究旨在评估直接经皮冠状动脉介入治疗（PCI）和溶栓治疗（TT）对65岁以上急性ST段抬高型心肌梗死（STEMI）患者院内不良事件、院内及长期死亡率的影响。
本研究共纳入111例经回顾性筛选的65岁以上STEMI患者（73例男性，平均年龄：73.4±5.9岁），这些患者接受了TT或直接PCI治疗。记录患者的特征、院内结局以及6个月和1年死亡率。
我们的研究纳入了111例65岁以上的STEMI患者（73例男性，38例女性）。其中，66例（59.5%）接受了溶栓治疗，45例（40.5%）接受了直接PCI治疗。TT组的门-针时间为25.9±7.8分钟，而PCI组的门-球囊时间为84.4±20.0分钟。溶栓组症状发作至入院时间为213.6±158.4分钟，PCI组为166.8±112.8分钟。TT组中有7例（10.6%）患者因再灌注失败接受了补救性PCI。TT组有5例（7.6%）患者发生再梗死，PCI组有2例（4.4%）患者发生再梗死。溶栓治疗组有1例（1.5%）患者发生非出血性卒中，PCI组有4例（8.9%）患者发生非出血性卒中。所有患者均未发生颅内出血。TT组有4例（6.1%）患者发生大出血，PCI组有4例（8.9%）患者发生大出血。溶栓组15例（22.7%）患者出现6个月死亡率，19例患者出现1年死亡率；PCI组分别有8例（17.8%）和8例（17.8%）患者出现6个月和1年死亡率。二元逻辑回归分析表明，患者年龄是1年死亡率的唯一预测因素（比值比（OR）=1.1，95%置信区间（CI）：1.019-1.188，P=0.015）。
根据我们的研究结果，考虑到院内不良结局、院内死亡率和6个月死亡率，TT和直接PCI对65岁及以上STEMI患者的影响相似。虽然TT组1年死亡率较高，但差异无统计学意义。
