Instituto de Enfermedades Cardiovasculares, Auna Clínica Las Américas, Diag 75B No. 2 A, 80/140, Medellin, Colombia.
Unidad de Cuidado Especial Cardiovascular, Auna Clínica Las Américas, Medellín, Colombia.
Aging Clin Exp Res. 2021 Aug;33(8):2213-2221. doi: 10.1007/s40520-020-01737-3. Epub 2020 Oct 24.
Although chest pain and acute coronary syndrome (ACS) are among the most common complaints in the Emergency Departments (ED), little is known about this topic in the octogenarian population.
This study aimed to describe the clinical presentation and to evaluate survival time according to the ACS type in a group of 80-year-old or over patients admitted for chest pain to an ED.
Patients were classified according to the discharge diagnosis. A multivariable Cox regression analysis was done to assess the association between ACS type and mortality with the non-ACS chest pain group as the reference category.
ACS was diagnosed in 170 of the 391 patients analyzed and 51% of ACS patients were female. Within the ACS patients, 18.8% presented STEMI, 57% NSTEMI, and 24% unstable angina (UA). Most of the patients were treated conservatively. In the adjusted analysis, the incidence of death at 40 months of follow-up was higher in patients with STEMI (HR 3.24; CI 1.59-6.56) than NSTEMI (HR 2.53; CI 1.56-4.11). There was no difference between patients with UA and the non-ACS group (HR 0.64; CI 0.26-1.58), and myocardial revascularization was associated with reduced mortality risk (HR 0.45; CI 0.22-0.92).
A high prevalence of ACS was found among octogenarians admitted to the ED with chest pain, and the ACS type behaved as an independent predictor of mortality. Patients with UA diagnosis had a similar prognosis to patients with non-ACS chest pain, but this needs to be demonstrated by a prospective study.
胸痛和急性冠状动脉综合征（ACS）是急诊科（ED）最常见的主诉之一，但关于 80 岁以上人群的这一主题知之甚少。
本研究旨在描述一组因胸痛入住 ED 的 80 岁或以上患者的临床表现，并根据 ACS 类型评估其生存时间。
根据出院诊断对患者进行分类。采用多变量 Cox 回归分析评估 ACS 类型与死亡率之间的关系，以非 ACS 胸痛组为参考类别。
在分析的 391 名患者中，诊断为 ACS 的有 170 名，ACS 患者中有 51%为女性。在 ACS 患者中，18.8%为 ST 段抬高型心肌梗死（STEMI），57%为非 ST 段抬高型心肌梗死（NSTEMI），24%为不稳定型心绞痛（UA）。大多数患者接受了保守治疗。在调整分析中，STEMI 患者（HR 3.24；95%CI 1.59-6.56）在 40 个月随访期间的死亡发生率高于 NSTEMI 患者（HR 2.53；95%CI 1.56-4.11）。UA 患者与非 ACS 组之间无差异（HR 0.64；95%CI 0.26-1.58），而进行心肌血运重建与降低死亡率风险相关（HR 0.45；95%CI 0.22-0.92）。
胸痛入住 ED 的 80 岁以上患者 ACS 患病率较高，ACS 类型是死亡率的独立预测因素。UA 诊断患者的预后与非 ACS 胸痛患者相似，但这需要前瞻性研究来证实。
