Sui Yong-Gang, Teng Si-Yong, Qian Jie, Wu Yuan, Dou Ke-Fei, Tang Yi-Da, Qiao Shu-Bin, Wu Yong-Jian
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Geriatr Cardiol. 2019 Oct;16(10):741-748. doi: 10.11909/j.issn.1671-5411.2019.10.006.
To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy.
190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed.
The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group ( = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10-1.03, = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56-8.53, = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77-6.75, = 0.0003), 3.02 (95% CI: 1.52-6.01, = 0.0017), 2.93 (95% CI: 1. 46-5.86, = 0.0024) and 2.47 (95% CI: 1.20-5.07, = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment ( < 0.001).
An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
探讨年龄≥80岁的非ST段抬高型心肌梗死（NSTEMI）患者采用侵入性策略与保守策略相比是否会从中获益。
纳入2014年9月至2017年8月期间190例年龄≥80岁的连续NSTEMI患者进行回顾性研究，其中69例患者接受保守策略，121例患者接受侵入性策略。主要结局为死亡。采用多因素Cox回归模型评估策略与死亡率之间的统计学关联。进一步分析生存概率。
侵入性组17.4%的患者发生主要结局，保守组为42.0%（P = 0.0002）。侵入性组的再入院率（14.9%）高于保守组（7.2%）。肌酐水平（OR = 1.01，95%CI：0.10 - 1.03，P = 0.05）和利尿剂的使用（OR = 3.65，95%CI：1.56 - 8.53，P = 0.003）是侵入性策略的独立影响因素。多因素Cox回归模型的HR分别为3.45（95%CI：1.77 - 6.75，P = 0.0003）、3.02（95%CI：1.52 - 6.01，P = 0.0017）、2.93（95%CI：1.46 - 5.86，P = 0.0024）和2.47（95%CI：1.20 - 5.07，P = 0.0137）。与接受侵入性策略的患者相比，保守组自治疗以来随时间推移生存概率显著降低（P < 0.001）。
侵入性策略在降低年龄≥80岁的NSTEMI患者死亡率方面优于保守策略。我们的结果表明，侵入性策略在中国年龄≥80岁的NSTEMI患者中更适用。
