Circulation. 2023 Jan 17;147(3):e32-e62. doi: 10.1161/CIR.0000000000001112. Epub 2022 Dec 12.
Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.
在过去几十年中,诊断和治疗方面的进展极大地改善了急性冠状动脉综合征患者的健康结局。随着年龄的增长,生理变化和累积的心血管危险因素都会增加一生中发生急性冠状动脉综合征的易感性。与年轻患者相比,年龄较大的成年人中急性冠状动脉综合征的结局相对较差。动脉粥样硬化斑块负担增加,解剖病变复杂,加上与年龄相关的心血管和非心血管合并症,导致观察到的老年患者预后较差。老年综合征,包括虚弱、多种合并症、认知和身体功能受损、多种药物治疗以及其他护理复杂性,可能会削弱基于指南的治疗的疗效,以及老年患者的生存和恢复能力。在这份美国心脏协会科学声明中,我们(1)回顾了导致急性冠状动脉综合征和管理复杂性的与年龄相关的生理变化;(2)描述了常见的老年综合征对心血管疾病结局的影响;(3)推荐了适合年龄的、符合指南的血运重建和急性冠状动脉综合征管理策略,包括护理过渡、心脏康复的应用、姑息治疗服务和整体方法。始终强调个体化风险评估和以患者为中心的护理决策制定的首要地位。