Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2022 Aug 1;25(8):523-532. doi: 10.34172/aim.2022.84.
Octogenarians (age≥80 years) with coronary artery disease constitute a high-risk group and the elderly undergoing percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared to young patients. In this study, we aimed to describe the outcomes of the elderly with acute coronary syndrome (ACS) who underwent PCI and also to identify the predictors of short-term major adverse cerebrocardiovascular events (MACCE) in octogenarians.
In this registry-based cohort study, we reviewed the data of patients (aged≥65 years) who underwent PCI. Univariate Cox-regression model was used to assess the univariate effects of covariates on mortality and MACCE and multivariate Cox-regression analysis were used to discover MACCE predictors.
We reviewed the data of 3332 patients (2722 elderly [65 to 79 years], and 610 octogenarians [≥80 years]). The cumulative hazard of MACCE was significantly higher in the octogenarian group compared with the younger group (<0.001). MACCE in octogenarians presenting with ST-elevation myocardial infarction (STEMI) was significantly higher than those with non-ST-elevation myocardial infarction/Unstable angina (NSTEMI/UA) (<0.001); however, the cumulative hazard of mortality was not significantly different between the two groups (=0.270). Successful PCI, left main stenosis and estimated glomerular filtration rate (eGFR) were independent predictors of MACCE in octogenarians with ACS.
Octogenarians undergoing PCI had a higher rate of MACCE and mortality compared with a younger population. In octogenarians, MACCE in those with STEMI was significantly higher than those with NSTEMI/UA and the mortality trend was similar; however, the 1-year trend was in favor of the STEMI subgroup.
80 岁以上（年龄≥80 岁）的冠心病患者属于高危人群，与年轻患者相比，老年患者经皮冠状动脉介入治疗（PCI）后发生不良结局的风险更高。本研究旨在描述接受 PCI 的老年急性冠状动脉综合征（ACS）患者的结局，并确定 80 岁以上患者短期主要不良心脑血管事件（MACCE）的预测因素。
本研究采用基于注册的队列研究，对接受 PCI 的患者（年龄≥65 岁）的数据进行了回顾性分析。采用单变量 Cox 回归模型评估协变量对死亡率和 MACCE 的单变量影响，采用多变量 Cox 回归分析发现 MACCE 的预测因素。
共纳入 3332 例患者（2722 例老年患者[65 至 79 岁]，610 例 80 岁以上患者）。与年轻组相比，80 岁以上组 MACCE 的累积发生率显著更高（<0.001）。80 岁以上组 ST 段抬高型心肌梗死（STEMI）患者的 MACCE 发生率明显高于非 ST 段抬高型心肌梗死/不稳定型心绞痛（NSTEMI/UA）患者（<0.001），但两组患者的死亡率无显著差异（=0.270）。成功的 PCI、左主干狭窄和估算肾小球滤过率（eGFR）是 ACS 老年患者 MACCE 的独立预测因素。
与年轻人群相比，接受 PCI 的 80 岁以上患者 MACCE 和死亡率更高。在 80 岁以上患者中，STEMI 患者的 MACCE 发生率明显高于 NSTEMI/UA 患者，死亡率趋势相似，但 1 年趋势有利于 STEMI 亚组。
