非高龄（90 岁及以上）人群 ST 段抬高型心肌梗死住院死亡率和再入院率：来自美国的全国性分析。
In-hospital mortality and readmission after ST-elevation myocardial infarction in nonagenarians: A nationwide analysis from the United States.
机构信息
Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
Division of Clinical Research and Evaluative Sciences, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
出版信息
Catheter Cardiovasc Interv. 2022 Jul;100(1):5-16. doi: 10.1002/ccd.30227. Epub 2022 May 14.
OBJECTIVES
To assess readmission rates in nonagenarians (age ≥ 90 years) with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) versus no pPCI.
BACKGROUND
There are limited data exploring readmissions following STEMI in nonagenarians undergoing pPCI versus no pPCI.
METHODS
We retrospectively analyzed the Nationwide Readmissions Database to identify nonagenarians hospitalized with STEMI. We divided the cohort into two groups based on pPCI status. We compared mortality during index hospitalization and during 30-day readmission, readmission rates, and causes of readmissions.
RESULTS
We identified 58,231 nonagenarian STEMI hospitalizations between 2010 and 2018, of which 18,809 (32.3%) included pPCI, and 39,422 (67.7%) had no pPCI. Unadjusted unplanned 30-day readmission was higher in pPCI cohort (21.0% vs. 15.4%, p < 0.001). However, mortality during index hospitalization and during 30-day readmission were significantly lower in pPCI cohort (15.8% vs. 32.2%, p < 0.001; 7.4% vs. 14.2%, p < 0.001, respectively). After adjusting for baseline characteristics, hospitalizations that included pPCI had 25% greater odds of unplanned 30-day readmission (adjusted odds ratio [aOR]: 1.25, 95% confidence interval [CI]: 1.12-1.39, p < 0.001) and 49% lower odds of in-hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46-0.56, p < 0.001). Heart failure was the most common cause of readmission in both cohorts followed by myocardial infarction.
CONCLUSIONS
In nonagenarians with STEMI, pPCI is associated with slightly higher 30-day readmission but significantly lower mortality during index hospitalization and during 30-day readmission than no pPCI. Given the overwhelming mortality benefit with pPCI, further research is necessary to optimize the utilization of pPCI while reducing readmissions following STEMI in nonagenarians.
目的
评估行直接经皮冠状动脉介入治疗（pPCI）与不行 pPCI 的 90 岁以上 ST 段抬高型心肌梗死（STEMI）患者的再入院率。
背景
目前仅有有限的数据探讨行 pPCI 与不行 pPCI 的 90 岁以上 STEMI 患者的再入院情况。
方法
我们回顾性分析了全国再入院数据库中 STEMI 住院的 90 岁以上患者。我们根据 pPCI 情况将队列分为两组。我们比较了指数住院期间和 30 天再入院期间的死亡率、再入院率和再入院原因。
结果
我们在 2010 年至 2018 年间确定了 58231 例 90 岁以上 STEMI 住院患者，其中 18809 例（32.3%）行 pPCI，39422 例（67.7%）不行 pPCI。pPCI 组未计划的 30 天再入院率更高（21.0%比 15.4%，p<0.001）。然而，pPCI 组指数住院期间和 30 天再入院期间的死亡率显著降低（15.8%比 32.2%，p<0.001；7.4%比 14.2%，p<0.001）。在校正基线特征后，包括 pPCI 的住院患者 30 天未计划再入院的可能性增加 25%（校正优势比[OR]：1.25，95%置信区间[CI]：1.12-1.39，p<0.001），指数住院期间的院内死亡率降低 49%（OR：0.51，95%CI：0.46-0.56，p<0.001）。心力衰竭是两个队列中再入院的最常见原因，其次是心肌梗死。
结论
在 STEMI 的 90 岁以上患者中，与不行 pPCI 相比，pPCI 与稍高的 30 天再入院率相关，但指数住院期间和 30 天再入院期间的死亡率显著降低。鉴于 pPCI 带来的压倒性死亡率获益，有必要进一步研究在减少 90 岁以上 STEMI 患者再入院的同时优化 pPCI 的应用。
Zotero 插件