Park Ik Hyun, Cho Hyun Kyu, Oh Ju Hyeon, Chun Woo Jung, Park Yong Hwan, Song Young Bin, Hahn Joo-Yong, Choi Seung-Hyuk, Lee Sang-Chol, Gwon Hyeon-Cheol, Choe Yeon Hyeon, Kim Jihoon, Jang Woo Jin
Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Am J Med Sci. 2021 Dec;362(6):592-600. doi: 10.1016/j.amjms.2021.06.023. Epub 2021 Sep 23.
Little is known about the causality and pathological mechanism underlying the association between old age and myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated the association between old age and myocardial injury in STEMI patients undergoing primary percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR).
A total of 279 patients with STEMI who underwent primary PCI and CMR were enrolled. Of these, 52 patients were over the age of 70 years (18.6%, Age ≥70 group) and 227 patients were under the age of 70 years (81.4%, Age <70 group) at STEMI occurrence. We compared myocardial infarct size on CMR according to age at STEMI occurrence and performed inverse probability of treatment weighting.
On CMR analysis, myocardial infarct size on CMR tended to be greater in the Age ≥70 group than in the Age <70 group (21.2 ± 10.2% versus 19.5 ± 11.1%; p = 0.072). After performing inverse probability of treatment weighting adjustment, myocardial infarct size was significantly greater in the Age ≥70 group compared with the Age <70 group (22.6 ± 10.4% versus 19.6 ± 11.1%; p = 0.001). Subgroup analysis of patients older than 70 years revealed no significant difference in myocardial infarct size according to sex (20.1 ± 11.5% in females versus 20.4 ± 9.9% in males; p = 0.901).
Despite appropriate coronary revascularization, old age was associated with greater extent of myocardial injury in STEMI patients.
关于ST段抬高型心肌梗死（STEMI）患者老年与心肌损伤之间关联的因果关系及病理机制，目前所知甚少。我们使用心血管磁共振成像（CMR）评估了接受直接经皮冠状动脉介入治疗（PCI）的STEMI患者中，老年与心肌损伤之间的关联。
共纳入279例接受直接PCI和CMR检查的STEMI患者。其中，52例患者在STEMI发病时年龄超过70岁（18.6%，年龄≥70岁组），227例患者在STEMI发病时年龄低于70岁（81.4%，年龄<70岁组）。我们根据STEMI发病时的年龄比较了CMR上的心肌梗死面积，并进行了治疗权重的逆概率分析。
在CMR分析中，年龄≥70岁组CMR上的心肌梗死面积往往大于年龄<70岁组（21.2±10.2%对19.5±11.1%；p = 0.072）。在进行治疗权重的逆概率调整后，年龄≥70岁组的心肌梗死面积显著大于年龄<70岁组（22.6±10.4%对19.6±11.1%；p = 0.001）。对70岁以上患者的亚组分析显示，根据性别，心肌梗死面积无显著差异（女性为20.1±11.5%，男性为20.4±9.9%；p = 0.901）。
尽管进行了适当的冠状动脉血运重建，但老年与STEMI患者更大范围的心肌损伤相关。
