Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
Open Heart. 2021 Dec;8(2). doi: 10.1136/openhrt-2021-001709.
Advancement in healthcare provision has led to increasing octogenarian ST elevation myocardial infarction (STEMI) presentation to hospital for early revascularisation therapies. Limited literature to date exists to suggest octogenarian STEMI population; with majority of trials excluding these age group patients. Due to an ageing population, we expect increasing rates of STEMI in the octogenarian and nonagenarian population in the future. This study seeks to identify the outcomes of patients over the age of 80 presenting with STEMI and determine the factors associated with better or worse outcome.
This study is a single-centre retrospective observational study involving patients' age 80 or older presenting with STEMI between January 2014 and December 2019. Patient data were collected by chart review and analysis of the local STEMI database. Standard Bayesian statistics were employed for analysis.
1301 patients presented with STEMI during this period. 159/1301 (12.2%) were 80 years or older that fulfilled STEMI criteria, 35/159 (22.1%) were medically managed. 107/124 (86.29%) had angiographic evidence of acute total or partial thrombotic occlusion, and 97/107 were treated with primary percutaneous coronary intervention (PPCI). The activation ECG most commonly exhibited an anterior STEMI, while inferior STEMI ECGs had the strongest positive predictive value. PPCI group had a 30-day mortality rate of 20% (p=0.07) and 1-year mortality was 22.4%. Highest mortality was observed with cardiogenic shock, low ejection fraction, higher high sensitivity cardiac troponin T and creatinine at presentation. Conservatively managed patients had significant higher mortality rate (48% vs 22.4%, p=0.005) at 1 year.
Patients over the age of 80 who present with STEMI and undergo PPCI have a significantly lower mortality rate at 1 year. These patients have a 77.6% survival at 1 year, with 92.4% likelihood of discharge to home (without need for long-term nursing home care). Cardiogenic shock in this group was associated with a 1-year mortality of 87.5%. Despite the advanced age, we suggest favourable outcomes described in the absence of patients presenting with cardiogenic shock.
医疗水平的提高导致越来越多的 80 岁以上 ST 段抬高型心肌梗死（STEMI）患者到医院接受早期血运重建治疗。目前，仅有有限的文献提示 80 岁以上 STEMI 患者人群，且大多数试验排除了这些年龄组患者。由于人口老龄化，我们预计未来 80 岁及 90 岁以上 STEMI 患者的比例将会增加。本研究旨在确定 80 岁以上 STEMI 患者的预后，并确定与预后更好或更差相关的因素。
本研究是一项单中心回顾性观察研究，纳入了 2014 年 1 月至 2019 年 12 月期间年龄在 80 岁或以上的 STEMI 患者。通过病历回顾和当地 STEMI 数据库分析收集患者数据。采用标准贝叶斯统计分析。
在此期间，共有 1301 例患者出现 STEMI，其中 159/1301（12.2%）为 80 岁或以上且符合 STEMI 标准，35/159（22.1%）采用药物治疗。107/124（86.29%）有急性完全或部分血栓闭塞的血管造影证据，97/107 接受了经皮冠状动脉介入治疗（PPCI）。激活心电图最常见表现为前壁 STEMI，而下壁 STEMI 心电图具有最强的阳性预测值。PPCI 组 30 天死亡率为 20%（p=0.07），1 年死亡率为 22.4%。心源性休克、射血分数低、入院时高敏肌钙蛋白 T 和肌酐水平升高的患者死亡率最高。保守治疗组 1 年死亡率显著升高（48%比 22.4%，p=0.005）。
80 岁以上 STEMI 患者接受 PPCI 治疗后 1 年死亡率显著降低。这些患者 1 年生存率为 77.6%，92.4%的患者可出院回家（无需长期护理院护理）。该组中心源性休克患者 1 年死亡率为 87.5%。尽管年龄较大，但在没有心源性休克患者的情况下，我们仍建议获得有利的预后。
