Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.
Heart. 2020 Sep;106(17):1296-1301. doi: 10.1136/heartjnl-2020-317011. Epub 2020 May 22.
Ischaemic heart disease (IHD), in particular acute coronary syndrome (ACS), comprising ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina, is the leading cause of death worldwide. Age is a major predictor of adverse outcome following ACS. COVID-19 infection seems to escalate the risk in older patients with heart disease. Increasing odds of in-hospital death is associated with older age following COVID-19 infection. Importantly, it seems older patients with comorbidities such as cardiovascular disease (CVD), in particular IHD, diabetes and hypertension, are at the highest risk of mortality following COVID-19 infection. The evidence is sparse on the optimal care of older patients with ACS with lack of robust randomised controlled trials. In this setting, with the serious threat imposed by the COVID-19 pandemic in the context of rapidly evolving knowledge with much unknown, it is important to weigh the risks and benefits of treatment strategies offered to older patients. In cases where risks outweigh the benefits, it might not be an unreasonable option to treat such patients with a conservative or a palliative approach. Further evidence to elucidate whether invasive management is beneficial in older patients with ACS is required out-with the COVID-19 pandemic. Though it is hoped that the actual acute phase of COVID-19 infection will be short lived, it is vital that important clinical research is continued, given the long-term benefits of ongoing clinical research for patients with long-term conditions, including CVD. This review aimed to evaluate the challenges and the management strategies in the care of older patients presenting with ACS in the context of the COVID-19 pandemic.
缺血性心脏病（IHD），特别是急性冠状动脉综合征（ACS），包括 ST 段抬高型心肌梗死、非 ST 段抬高型心肌梗死和不稳定型心绞痛，是全球范围内主要的死亡原因。年龄是 ACS 后不良结局的主要预测因素。COVID-19 感染似乎会使老年心脏病患者的风险升级。COVID-19 感染后，年龄越大，住院死亡的几率就越高。重要的是，患有合并症（如心血管疾病（CVD），特别是 IHD、糖尿病和高血压）的老年患者似乎面临最高的 COVID-19 感染后死亡风险。关于 ACS 老年患者的最佳治疗方法，证据不足，缺乏强有力的随机对照试验。在这种情况下，鉴于 COVID-19 大流行带来的严重威胁，以及知识的迅速发展和许多未知因素，权衡为老年患者提供的治疗策略的风险和益处非常重要。如果风险超过收益，对这些患者采取保守或姑息治疗可能不是不合理的选择。需要在 COVID-19 大流行之外进一步提供证据，以阐明在 ACS 老年患者中进行有创性治疗是否有益。虽然人们希望 COVID-19 感染的急性期能很快过去，但重要的是要继续进行重要的临床研究，因为持续的临床研究对包括 CVD 在内的长期疾病患者的长期获益。本综述旨在评估 COVID-19 大流行背景下 ACS 老年患者护理方面的挑战和管理策略。
