Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.
Age Ageing. 2024 Aug 6;53(8). doi: 10.1093/ageing/afae179.
Older people less frequently receive invasive coronary angiography (ICA) for NSTEMI than younger patients. We describe care, ICA data, and in-hospital and 30-day outcomes of NSTEMI by age in a contemporary and geographically diverse cohort.
Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by age (≥75 years, n = 761). Quality of care was evaluated based on 12 guideline-recommended care interventions, and data collected on ICA. Outcomes included in hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack, BARC Type ≥3 bleeding and death, as well as 30-day mortality.
Patients aged ≥75 years, compared with younger patients, at presentation had a higher prevalence of comorbidities and oral anticoagulation prescription (22.4% vs 7.6%, p < 0.001). Older patients less frequently received ICA than younger patients (78.6% vs 90.6%, p < 0.001) with the recorded reason more often being advanced age, comorbidities or frailty. Of those who underwent ICA, older patients more frequently demonstrated 3-vessel, 4-vessel and/or left main stem coronary artery disease compared to younger patients (49.7% vs 34.1%, p < 0.001) but less frequently received revascularisation (63.6% vs 76.9%, p < 0.001). Older patients experienced higher rates of in-hospital acute heart failure (15.0% vs 8.4%, p < 0.001) and bleeding (2.8% vs 1.3%, p = 0.006), as well as in-hospital and 30-day mortality (3.4% vs 1.3%, p < 0.001; 4.8% vs 1.7%, p < 0.001; respectively), than younger patients.
Patients aged ≥75 years with NSTEMI, compared with younger patients, less frequently received ICA and guideline-recommended care, and had worse short-term outcomes.
与年轻患者相比，老年患者接受非 ST 段抬高型心肌梗死（NSTEMI）有创冠状动脉造影（ICA）的频率较低。我们描述了在一个现代和地理上多样化的队列中，按年龄划分的 NSTEMI 的护理、ICA 数据以及院内和 30 天结局。
前瞻性队列研究纳入了来自 59 个国家的 287 个中心的 2947 例 NSTEMI 患者，分为年龄（≥75 岁，n=761）。根据 12 项指南推荐的护理干预措施评估护理质量，并收集 ICA 数据。结局包括院内急性心力衰竭、心源性休克、再发心肌梗死、卒中和短暂性脑缺血发作、BARC 类型≥3 级出血和死亡，以及 30 天死亡率。
与年轻患者相比，年龄≥75 岁的患者就诊时更常见合并症和口服抗凝药物处方（22.4%比 7.6%，p<0.001）。与年轻患者相比，老年患者接受 ICA 的频率较低（78.6%比 90.6%，p<0.001），记录的原因更多的是高龄、合并症或衰弱。在接受 ICA 的患者中，与年轻患者相比，老年患者更常出现 3 支血管、4 支血管和/或左主干冠状动脉疾病（49.7%比 34.1%，p<0.001），但较少接受血运重建（63.6%比 76.9%，p<0.001）。老年患者院内急性心力衰竭（15.0%比 8.4%，p<0.001）和出血（2.8%比 1.3%，p=0.006）的发生率以及院内和 30 天死亡率（3.4%比 1.3%，p<0.001；4.8%比 1.7%，p<0.001）均高于年轻患者。
与年轻患者相比，年龄≥75 岁的 NSTEMI 患者接受 ICA 和指南推荐的护理的频率较低，短期结局较差。
