非 ST 段抬高型心肌梗死和新一代药物洗脱支架植入术后 3 年结局，按患者年龄（<75 岁和≥75 岁）和左心室射血分数分层：一项前瞻性队列研究。
Three-year outcomes following non-ST-segment elevation myocardial infarction and new-generation drug-eluting stent implantation, stratified by patient age (under and over 75 years) and left ventricular ejection fraction: A prospective cohort study.
机构信息
Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea.
出版信息
Medicine (Baltimore). 2024 Sep 13;103(37):e39606. doi: 10.1097/MD.0000000000039606.
Due to limited published data, we investigated 3-year outcomes according to left ventricular ejection fraction (LVEF) in patients older and younger than 75 years with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent successful newer-generation drug-eluting stent (DES) implantation. This research analyzed the data of 4558 patients (1032 older adults [≥75 years] and 3526 younger adults [<75 years]) from the Korea Acute MI Registry-NIH. We further divided the older group based on LVEF: heart failure (HF) with reduced EF (HFrEF, ≤40%, n = 196; group A), HF with mildly reduced EF (HFmrEF, 41-49%, n = 228; group B), and HF with preserved EF (HFpEF, ≥50%, n = 608; group C). Similarly, the younger group was divided into HFrEF (group D, n = 353), HFmrEF (group E, n = 577), and HFpEF (group F, n = 2596). The primary outcome was a composite of major adverse cardiac events (MACE) at 3 years, including all-cause death, recurrent MI, any repeat revascularization, or hospitalization for HF. MACE rates were highest in the HFrEF groups (A and D), followed by the HFmrEF groups (B and E), and lowest in the HFpEF groups (C and F) for both age groups. All-cause death, cardiac death (CD), all-cause death or MI, and hospitalization for HF rates were higher in group A than in groups B and C, and higher in group D than in groups E and F. Across all LVEF categories, MACE, all-cause death, CD, and non-CD, and all-cause death or MI rates were higher in the older group. This multicenter cohort study demonstrates that older patients have higher mortality rates compared to younger patients. Additionally, MACE rates were highest in the HFrEF group, followed by the HFmrEF group, and lowest in the HFpEF group across both age groups. Further research is needed to confirm these findings.
由于发表的数据有限，我们根据接受新一代药物洗脱支架（DES）成功植入的年龄大于和小于 75 岁的非 ST 段抬高型心肌梗死（NSTEMI）患者的左心室射血分数（LVEF）调查了 3 年的结果。这项研究分析了来自韩国急性心肌梗死登记处- NIH 的 4558 名患者（1032 名老年人[≥75 岁]和 3526 名年轻人[<75 岁]）的数据。我们根据 LVEF 进一步将老年人分为心力衰竭（HF）射血分数降低（HFrEF，≤40%，n=196；A 组）、HF 射血分数轻度降低（HFmrEF，41-49%，n=228；B 组）和 HF 射血分数保留（HFpEF，≥50%，n=608；C 组）。同样，年轻组也分为 HFrEF（D 组，n=353）、HFmrEF（E 组，n=577）和 HFpEF（F 组，n=2596）。主要终点是 3 年内的主要不良心脏事件（MACE）的复合终点，包括全因死亡、复发性 MI、任何再次血运重建或因 HF 住院。在两个年龄组中，HFrEF 组（A 和 D）的 MACE 发生率最高，其次是 HFmrEF 组（B 和 E），HFpEF 组（C 和 F）的发生率最低。与 B 组和 C 组相比，A 组的全因死亡、心脏性死亡（CD）、全因死亡或 MI 以及 HF 住院率更高，D 组的全因死亡、CD 和非 CD 以及全因死亡或 MI 住院率均高于 E 组和 F 组。在所有 LVEF 类别中，老年组的 MACE、全因死亡、CD 和非 CD 以及全因死亡或 MI 发生率均高于年轻组。这项多中心队列研究表明，与年轻患者相比，老年患者的死亡率更高。此外，在两个年龄组中，HFrEF 组的 MACE 发生率最高，其次是 HFmrEF 组，HFpEF 组的发生率最低。需要进一步的研究来证实这些发现。
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