Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
J Cardiol. 2020 May;75(5):465-472. doi: 10.1016/j.jjcc.2019.10.006. Epub 2019 Nov 13.
Along with the global aging, the number of geriatric patients with acute myocardial infarction (AMI) has been increasing. However, temporal trends in the prevalence and outcomes of geriatric patients with AMI, with a special reference to heart failure (HF) on admission, remain to be elucidated.
The Miyagi AMI Registry is a prospective, multicenter, and observational study. This registry was established in 1979 and has been continued for 40 years. We examined a total of 6,596 AMI patients aged ≥70 years (male/female 4,141/2,455) registered in this registry from 2005 to 2016 and divided them into 3 groups according to age [70-79 (n = 3,485), 80-89 (n = 2,601), and ≥90 years (n = 510)].
Of those, 17.6% had HF (Killip class ≥ II) on admission, for which age, female sex, diabetes, and previous MI were identified as independent predictors. Importantly, the prevalence of HF on admission significantly increased in all ages during the study period (all p for trend <0.01). Despite the presence of HF on admission, primary percutaneous coronary intervention (PCI) was performed in about 70% of patients aged in their 80 s and about half of those aged ≥90 years. In each group, performance rate of primary PCI also progressively increased (all p < 0.05) irrespective of concomitant HF. However, in-hospital mortality remained unchanged. Multivariable analysis demonstrated that, even for patients with HF on admission, primary PCI was associated with improved in-hospital mortality in the younger 2 groups [adjusted odds ratios (ORs), 95% confidence intervals (CI) 0.58 (0.36-0.93) for 70s, 0.64 (0.43-0.95) for 80s, and 0.99 (0.44-2.21) for ≥90s], whereas PCI was ineffective to reduce long-term hospitalization ≥30 days in all groups [adjusted ORs (95%CI) 0.90 (0.52-1.54), 0.66 (0.38-1.14), and 0.38 (0.07-2.10)].
These results demonstrate that increasing prevalence of HF on admission and increasing performance of primary PCI counteract each other with resultant unchanged in-hospital outcomes in geriatric AMI patients in Japan.
随着全球人口老龄化，急性心肌梗死（AMI）的老年患者数量不断增加。然而，老年 AMI 患者的流行趋势和结局，特别是入院时的心衰（HF）情况，仍有待阐明。
宫城 AMI 登记研究是一项前瞻性、多中心、观察性研究。该登记研究于 1979 年建立，至今已连续开展 40 年。我们共纳入了该登记研究中 2005 年至 2016 年间年龄≥70 岁（男/女：4141/2455）的 6596 例 AMI 患者，并根据年龄将其分为 3 组[70-79 岁（n=3485）、80-89 岁（n=2601）和≥90 岁（n=510）]。
其中入院时 HF（Killip 分级≥Ⅱ）的比例为 17.6%，年龄、女性、糖尿病和既往心肌梗死被确定为独立预测因素。重要的是，在整个研究期间，各年龄段入院时 HF 的患病率均显著增加（所有趋势 p 值均<0.01）。尽管入院时存在 HF，但 80 多岁的患者中有近 70%和≥90 岁的患者中有一半接受了直接经皮冠状动脉介入治疗（PCI）。在每个年龄组中，无论是否伴有 HF，直接 PCI 的实施率均呈逐渐增加趋势（所有 p 值均<0.05）。然而，住院期间死亡率保持不变。多变量分析表明，即使对于入院时存在 HF 的患者，直接 PCI 也与年轻 2 组患者住院期间死亡率的降低相关[校正比值比（OR），70 岁组为 0.58（0.36-0.93），80 岁组为 0.64（0.43-0.95），≥90 岁组为 0.99（0.44-2.21）]，而直接 PCI 对降低所有年龄组住院≥30 天的长期住院率均无效果[校正 OR（95%CI），70 岁组为 0.90（0.52-1.54），80 岁组为 0.66（0.38-1.14），≥90 岁组为 0.38（0.07-2.10）]。
这些结果表明，日本老年 AMI 患者入院时 HF 患病率的增加和直接 PCI 实施率的增加相互抵消，导致住院期间结局没有变化。
