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三级医院老年急性心肌梗死患者经皮冠状动脉介入治疗的选择

Selection of percutaneous coronary intervention in elderly patients with acute myocardial infarction in tertiary hospital.

作者信息

Chen Liwei, Han Ling, Luo Jingguang

机构信息

Department of Cardiology, Fuxing Hospital, Capital Medical University, Beijing, China.

出版信息

Medicine (Baltimore). 2019 Jul;98(29):e16544. doi: 10.1097/MD.0000000000016544.

Abstract

To investigate the status of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI) and analyze the reasons for not receiving PCI.A cohort of 387 consecutive hospitalized AMI patients aged ≥80 years were recruited from 2005 to 2014. Their clinical data were collected and analyzed.Among 387 elderly patients with AMI (190 men and 197 women, mean age 84.1 ± 3.9 years), there were 171 patients with ST-elevation myocardial infarction (STEMI) and 216 patients with non-ST-elevation myocardial infarction (NSTEMI). The emergency and elective PCI treatment rate was 40.6% and 12.1%, respectively, in patients with STEMI; and 1% and 18%, respectively, in patients with NSTEMI. PCI treatment rate of elderly AMI patients enrolled after 2009 showed no significant difference compared to that before 2009 (P > .05). The in-hospital mortality decreased significantly in PCI treatment group. After adjustment for age, sex, and other factors, PCI treatment was identified as the independent protective factors for in-hospital mortality (odds ratio = 0.323, 95% confidence interval 0.147-0.710, P = .005). The main influence factors for not receiving PCI treatment were hemorrhage, severe renal dysfunction, infection, or severe anemia-associated complications, whereas delayed treatment was the important reason for patients not undergoing emergency PCI.PCI treatment is the independent protective factor for in-hospital mortality of elderly patients with AMI. Due to various complications, PCI treatment rate is still low in elderly patients with AMI and has not been improved recently. Paying attention to performing PCI treatment for elderly patients with AMI has positive significance.

摘要

探讨老年急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)的现状,并分析未接受PCI治疗的原因。选取2005年至2014年连续住院的387例年龄≥80岁的AMI患者作为研究对象。收集并分析其临床资料。387例老年AMI患者(男性190例,女性197例,平均年龄84.1±3.9岁)中,ST段抬高型心肌梗死(STEMI)患者171例,非ST段抬高型心肌梗死(NSTEMI)患者216例。STEMI患者的急诊和择期PCI治疗率分别为40.6%和12.1%;NSTEMI患者的急诊和择期PCI治疗率分别为1%和18%。2009年后纳入的老年AMI患者的PCI治疗率与2009年前相比差异无统计学意义(P>0.05)。PCI治疗组的住院死亡率显著降低。在调整年龄、性别和其他因素后,PCI治疗被确定为住院死亡率的独立保护因素(比值比=0.323,95%置信区间0.147-0.710,P=0.005)。未接受PCI治疗的主要影响因素是出血、严重肾功能不全、感染或严重贫血相关并发症,而治疗延迟是患者未接受急诊PCI的重要原因。PCI治疗是老年AMI患者住院死亡率的独立保护因素。由于各种并发症,老年AMI患者的PCI治疗率仍然较低,且近期未得到改善。重视对老年AMI患者进行PCI治疗具有积极意义。

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