Perl Leor, Franzé Alfonso, D'Ascenzo Fabrizio, Golomb Noa, Levi Amos, Vaknin-Assa Hana, Greenberg Gabriel, Assali Abid, De Ferrari Gaetano M, Kornowski Ran
Department of Cardiology, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
J Clin Med. 2021 May 30;10(11):2435. doi: 10.3390/jcm10112435.
: Little is known regarding primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) in the elderly. Data on 319 octogenarians, 641 septuagenarians, and 2451 younger patients was collected from an ongoing prospective registry of patients treated with pPCI for STEMI at two Mediterranean-area medical centers in 2009-2017. : More octogenarian patients were female (40.8 vs. 31.9 septuagenarians and 26.5% under 70 y, < 0.01), had hypertension (79.5 vs. 69.5 and 45.9%, < 0.01), renal failure (32.5 vs. 20.1 and 5.2%, < 0.01), and a lower left-ventricular ejection fraction (42.0 vs. 44.9 and 47.6%, = 0.012). At 1 month and 3 years after intervention, mortality was higher in the octogenarian patients (12.2 vs. 7.9%, = 0.01; and 36.7 vs. 23.1%, < 0.01, respectively), with no significant differences in the rates of recurrent myocardial infarction, target vessel revascularization, coronary artery bypass surgery, and cardiovascular death. Following adjustment for confounders, 3-year mortality was significantly higher in the octogenarians (HR 3.89 vs. 3.19 for septuagenarians, < 0.01), but rates of major adverse cardiac events or cardiovascular death were not. : Despite suffering from higher all-cause mortality, octogenarian patients treated with pPCI for STEMI do not suffer an increased risk of ischemic cardiac events relative to younger patients.
关于老年患者ST段抬高型心肌梗死（STEMI）的直接经皮冠状动脉介入治疗（pPCI），人们了解甚少。2009年至2017年期间，从地中海地区两家医疗中心正在进行的STEMI患者pPCI治疗前瞻性登记中收集了319名八旬老人、641名七旬老人和2451名年轻患者的数据。八旬老人中女性患者更多（40.8%，七旬老人为31.9%，70岁以下为26.5%，P<0.01），患有高血压（79.5%，七旬老人为69.5%，70岁以下为45.9%，P<0.01）、肾衰竭（32.5%，七旬老人为20.1%，70岁以下为5.2%，P<0.01），且左心室射血分数较低（42.0%，七旬老人为44.9%，70岁以下为47.6%，P=0.012）。干预后1个月和3年时，八旬老人的死亡率更高（分别为12.2%和7.9%，P=0.01；36.7%和23.1%，P<0.01），在心肌梗死复发率、靶血管血运重建率、冠状动脉搭桥手术率和心血管死亡率方面无显著差异。在对混杂因素进行调整后，八旬老人的3年死亡率显著更高（与七旬老人相比，风险比为3.89对3.19，P<0.01），但主要不良心脏事件或心血管死亡的发生率没有差异。尽管全因死亡率较高，但接受pPCI治疗的STEMI八旬老人相对于年轻患者，缺血性心脏事件风险并未增加。
