Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
Department of Gynecology and Obstetrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Clin Interv Aging. 2020 May 21;15:715-722. doi: 10.2147/CIA.S218827. eCollection 2020.
There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS.
Between January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation.
A total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥75 years of age. Compared to patients <75 years, those ≥75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients <75 years of age, in-hospital MACE and mortality were higher in patients with ≥75 years (6.5% versus 19.4%; p<0.001; and 4.0% versus 18.2%; p<0.001, respectively). Patients ≥75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p<0.001). By multivariable analysis, age ≥75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12-3.82, p=0.020).
In patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients <75 years of age.
在接受药物侵入性策略（PIS）的患者中，年龄≥75 岁与<75 岁的疗效和安全性研究甚少。我们旨在评估和比较高龄对接受 PIS 的患者死亡和主要不良心脏事件（MACE）风险的影响。
2010 年 1 月至 2016 年 11 月，巴西圣保罗的 14 家市立急诊室使用特美汀的全剂量治疗 STEMI 患者，作为当地网络实施的药物侵入性策略的一部分。
共评估了 1852 例接受 PIS 的患者，其中 160 例（9%）年龄≥75 岁。与<75 岁的患者相比，年龄≥75 岁的患者更常见为女性，体重指数较低，高血压发生率较高；甲状腺功能减退症、慢性肾衰竭、既往中风和糖尿病的发生率较高。与<75 岁的患者相比，年龄≥75 岁的患者住院期间的 MACE 和死亡率更高（6.5%比 19.4%；p<0.001；4.0%比 18.2%；p<0.001）。年龄≥75 岁的患者院内主要出血发生率较高（2.7%比 5.6%；p=0.04），心源性休克发生率较高（7.0%比 19.6%；p<0.001）。多变量分析显示，年龄≥75 岁是 MACE（OR 3.57，95%CI 1.72 至 7.42，p=0.001）和死亡（OR 2.07，95%CI 1.12 至 3.82，p=0.020）的独立预测因素。
在接受 PIS 的 ST 段抬高型心肌梗死患者中，年龄≥75 岁是一个独立的因素，与<75 岁的患者相比，MACE 风险增加 3.5 倍，死亡率增加 2 倍。
