Hassan Ahmed, Emam Amr Yosry, Thabet Mohammed, Osman Ahmed, Shams Khaled Ahmed, Labib Mina Samir, Elguindy Ahmed
Cairo University, Egypt.
Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.
Glob Heart. 2024 Dec 30;19(1):99. doi: 10.5334/gh.1383. eCollection 2024.
The global trend of population aging has resulted in more frequent cardiovascular disease among seniors. Primary percutaneous coronary intervention (pPCI) is the standard of care for ST-elevation myocardial infarction (STEMI) without an upper age limit. Nevertheless, the outcomes are variable among studies, and data on pPCI outcomes in the elderly in Africa is scarce. Thus, we attempted to gain better insight into the outcomes of primary PCI in this age group from a single center in upper Egypt.
To study the patient characteristics and in-hospital outcomes of pPCI in elderly patients presenting with STEMI in a tertiary cardiac center in upper Egypt.
This observational cohort study was based on data from the pPCI registry in a tertiary cardiac center in upper Egypt, which included 3,627 consecutive patients who underwent pPCI between January 2014 and June 2023. The elderly were defined as those aged 70 years or older and represented 15.9% (575 patients) of the entire cohort, of whom 103 (2.8%) were octogenarians. Clinical characteristics, procedural details, and in-hospital outcomes were compared between the age groups. The elderly had a significant trend of being female and hypertensive, and having chronic kidney disease (CKD), worse Killip class, more frequent severe non-culprit vessel lesions, and left main trunk involvement. The in-hospital mortality was significantly higher than that of younger patients (14.1 vs. 4%, p = <0.001), with higher mortality in octogenarians (23.3%). Killip class ≥II was independently associated with increased hospital mortality in all study age groups. Contrast-induced nephropathy and TIMI major bleeding were also significantly higher.
Compared to younger patients, elderly patients undergoing pPCI had a higher prevalence of hypertension and CKD and were more likely to have a worse Killip class. The radial approach was utilized less often in the elderly group. In-hospital complications and mortality, particularly among the octogenarians, were significantly higher than in younger patients.
全球人口老龄化趋势导致老年人心血管疾病更为频发。直接经皮冠状动脉介入治疗（pPCI）是无年龄上限的ST段抬高型心肌梗死（STEMI）的标准治疗方法。然而，各研究结果存在差异，非洲老年人pPCI结局的数据也很匮乏。因此，我们试图从埃及上埃及的一个单一中心更好地了解该年龄组原发性PCI的结局。
研究埃及上埃及一家三级心脏中心中，老年STEMI患者接受pPCI的患者特征及院内结局。
这项观察性队列研究基于埃及上埃及一家三级心脏中心pPCI登记处的数据，该登记处纳入了2014年1月至2023年6月期间连续接受pPCI的3627例患者。老年人定义为年龄70岁及以上，占整个队列的15.9%（575例患者），其中103例（2.8%）为八旬老人。对各年龄组的临床特征、手术细节及院内结局进行了比较。老年人女性、高血压、患有慢性肾脏病（CKD）、Killip分级较差、严重非罪犯血管病变及左主干受累更为常见。院内死亡率显著高于年轻患者（14.1%对4%，p = <0.001），八旬老人死亡率更高（23.3%）。Killip分级≥II在所有研究年龄组中均与院内死亡率增加独立相关。对比剂肾病和TIMI大出血也显著更高。
与年轻患者相比，接受pPCI的老年患者高血压和CKD患病率更高，Killip分级更差的可能性更大。老年组较少采用桡动脉入路。院内并发症和死亡率，尤其是八旬老人，显著高于年轻患者。
