经皮冠状动脉介入治疗对老年急性心肌梗死住院患者的预后影响：来自伦巴第健康数据库的真实世界研究结果

Prognostic Impact of Percutaneous Coronary Intervention in Older Patients Hospitalized with Acute Myocardial Infarction: Real-World Findings from the Lombardy Health Database.

作者信息

Marenzi Giancarlo, Cosentino Nicola, Resta Marta, Lucci Claudia, Bonomi Alice, Trombara Filippo, Della Rocca Michele, Poggio Paolo, Leoni Olivia, Bortolan Francesco, Savonitto Stefano, Agostoni Piergiuseppe

机构信息

Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy.

Regional Epidemiological Observatory, Lombardy Region, 20138 Milan, Italy.

出版信息

J Clin Med. 2023 Aug 29;12(17):5629. doi: 10.3390/jcm12175629.

DOI:10.3390/jcm12175629

PMID:37685696

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10488530/

Abstract

BACKGROUND

Older patients are less likely to receive percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) compared to younger patients. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018 by using the administrative Lombardy Health Database (Italy).

METHODS

We considered all patients aged ≥75 years hospitalized with AMI (either STEMI or NSTEMI) from 2003 to 2018 in Lombardy. Patients were grouped according to whether they were treated or not with PCI during the index hospitalization. The primary outcome was in-hospital mortality. The secondary endpoints were 1-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI.

RESULTS

116,063 patients aged ≥75 years (mean age 83 ± 6; 48% males; 46% STEMI) were hospitalized with a primary diagnosis of AMI. Thirty-seven percent of them ( = 42,912) underwent PCI. The in-hospital mortality rate was significantly lower in PCI-treated patients (6% vs. 15%; < 0.0001). One-year mortality and 1-year re-hospitalization for AHF/AMI were less frequent in PCI-treated patients (16% vs. 41% and 15% vs. 21%, respectively; < 0.0001). The adjusted risks of the study endpoints were lower in PCI-treated patients: OR 0.37 (95% CI 0.36-0.39) for in-hospital mortality; HR 0.37 (95% CI 0.36-0.38) for 1-year mortality; HR 0.74 (95% CI 0.71-0.77) for 1-year re-hospitalization for AHF/AMI. Similar results were found in STEMI and NSTEMI patients considered separately.

CONCLUSIONS

Our real-world data showed that in patients with AMI ≥ 75 years of age, PCI use is associated with lower in-hospital and 1-year mortality.

摘要

背景

与年轻患者相比，老年患者急性心肌梗死（AMI）接受经皮冠状动脉介入治疗（PCI）的可能性较小。我们通过使用伦巴第行政区卫生数据库（意大利），调查了2003年至2018年期间大量因AMI住院患者中PCI的预后影响。

方法

我们纳入了2003年至2018年在伦巴第因AMI（ST段抬高型心肌梗死或非ST段抬高型心肌梗死）住院的所有年龄≥75岁的患者。根据他们在首次住院期间是否接受PCI治疗进行分组。主要结局是住院死亡率。次要终点是1年死亡率以及因急性心力衰竭（AHF）或AMI再次住院1年。

结果

116063例年龄≥75岁（平均年龄83±6岁；48%为男性；46%为ST段抬高型心肌梗死）的患者因AMI的初步诊断而住院。其中37%（=42912例）接受了PCI治疗。PCI治疗患者的住院死亡率显著较低（6%对15%；P<0.0001）。PCI治疗患者1年死亡率以及因AHF/AMI再次住院1年的情况较少见（分别为16%对41%和15%对21%；P<0.0001）。PCI治疗患者研究终点的校正风险较低：住院死亡率的OR为0.37（95%CI 0.36 - 0.39）；1年死亡率的HR为0.37（95%CI 0.36 - 0.38）；因AHF/AMI再次住院1年的HR为0.74（95%CI 0.71 - 0.77）。在分别考虑的ST段抬高型心肌梗死和非ST段抬高型心肌梗死患者中发现了类似结果。