Department of Cardiology, Miyazaki Medical Association Hospital.
Clinical Research Support Center, University of Miyazaki Hospital.
Circ J. 2024 May 24;88(6):931-937. doi: 10.1253/circj.CJ-23-0837. Epub 2024 Jan 18.
The efficacy of guideline-directed medical therapy (GDMT) in the elderly remains unclear. This study evaluated the impact of GDMT (aspirin or a P2Yinhibitor, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and statin) at discharge on long-term mortality in elderly patients with acute myocardial infarction (AMI) who had undergone percutaneous coronary intervention (PCI).
Of 2,547 consecutive patients with AMI undergoing PCI in 2009-2020, we retrospectively analyzed 573 patients aged ≥80 years. The median follow-up period was 1,140 days. GDMT was prescribed to 192 (33.5%) patients at discharge. Compared with patients without GDMT, those with GDMT were younger and had higher rates of ST-segment elevation myocardial infarction and left anterior descending artery culprit lesion, higher peak creatine phosphokinase concentration, and lower left ventricular ejection fraction (LVEF). After adjusting for confounders, GDMT was independently associated with a lower cardiovascular death rate (hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.16-0.81), but not with all-cause mortality (HR 0.77; 95% CI 0.50-1.18). In the subgroup analysis, the favorable impact of GDMT on cardiovascular death was significant in patients aged 80-89 years, with LVEF <50%, or with an estimated glomerular filtration rate ≥30 mL/min/1.73 m.
GDMT in patients with AMI aged ≥80 years undergoing PCI was associated with a lower cardiovascular death rate but not all-cause mortality.
指南指导的医学治疗（GDMT）在老年人中的疗效仍不清楚。本研究评估了接受经皮冠状动脉介入治疗（PCI）的老年急性心肌梗死（AMI）患者出院时 GDMT（阿司匹林或 P2Y 抑制剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂和他汀类药物）对长期死亡率的影响。
在 2009 年至 2020 年期间，对 2547 例接受 PCI 的连续 AMI 患者进行回顾性分析，其中包括 573 例年龄≥80 岁的患者。中位随访时间为 1140 天。出院时开具 GDMT 的患者有 192 例（33.5%）。与未接受 GDMT 的患者相比，接受 GDMT 的患者年龄较小，ST 段抬高型心肌梗死和左前降支罪犯病变发生率较高，肌酸磷酸激酶峰值浓度较低，左心室射血分数（LVEF）较低。在调整混杂因素后，GDMT 与较低的心血管死亡率独立相关（风险比[HR]0.35；95%置信区间[CI]0.16-0.81），但与全因死亡率无关（HR 0.77；95%CI 0.50-1.18）。在亚组分析中，GDMT 对心血管死亡的有利影响在年龄 80-89 岁、LVEF<50%或估算肾小球滤过率≥30 mL/min/1.73 m 的患者中更为显著。
在接受 PCI 的年龄≥80 岁的 AMI 患者中，GDMT 与较低的心血管死亡率相关，但与全因死亡率无关。
