Kuhn Lasse, Schupp Tobias, Steinke Philipp, Dudda Jonas, Abumayyaleh Mohammad, Weidner Kathrin, Bertsch Thomas, Rusnak Jonas, Akin Ibrahim, Behnes Michael
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.
Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany.
J Clin Med. 2025 Jan 31;14(3):928. doi: 10.3390/jcm14030928.
: The study investigates age-related differences in the prevalence and extent of coronary artery disease (CAD), as well as long-term outcomes in a large cohort of unselected patients undergoing invasive coronary angiography (CA). The aging population, along with an increasing number of older and multi-morbid patients undergoing CA, poses challenges for healthcare systems. Despite this, studies investigating age-related differences in the long-term outcomes of unselected patients undergoing CA are limited. : Consecutive patients undergoing invasive CA from 2016 to 2022 were included from one institution. The prognosis of patients undergoing CA stratified by pre-specified age groups (i.e., 40-<60, 60-<80 and ≥80 years) was investigated with regard to the primary endpoint of rehospitalization for heart failure (HF), as well as the risks of acute myocardial infarction (AMI) and coronary revascularization at 36 months. : From 2016 to 2022, 7520 patients undergoing CA were included with a median age of 70 years (mean: 69 years). The prevalence of CAD (61.9% vs. 71.8% vs. 77.3%; = 0.001), as well as the prevalence of three-vessel CAD (21.0% vs. 31.5% vs. 36.1%) increased with age. At 36 months, patients ≥ 80 years of age had the highest rates of rehospitalization for HF, followed by patients 60-<80 years and patients 40-<60 years (28.4% vs. 23.2% vs. 14.0%; = 0.001). Consequently, compared to younger patients (i.e., 40-<60 years of age), those ≥80 years of age exhibited the highest risk of HF-related rehospitalization (≥ 80 years: HR = 2.205; 95% CI 1.884-2.579; = 0.001), followed by those 60-< 80 years (HR = 1.765; 95% CI 1.536-2.029; = 0.001). The increased risk of rehospitalization for HF at 36 months was still observed after multivariable adjustment (i.e., ≥80 years: HR = 1.265; 95% CI 1.049-1.524; = 0.014; 60-<80 years: HR = 1.339; 95% CI 1.145-1.565; = 0.001) and was specifically evident in patients with left ventricular ejection fraction ≥ 35% and in patients without evidence of CAD/single-vessel CAD. In contrast, the rates of AMI and coronary revascularization at 36 months did not differ significantly among different age groups. : Advanced age is an independent predictor of rehospitalization for HF in patients undergoing CA, but not AMI and revascularization during long-term follow-up. This highlights the importance of optimizing diagnostic and therapeutic strategies for HF, particularly in older patients undergoing CA.
本研究调查了冠状动脉疾病（CAD）的患病率和病变程度与年龄的关系，以及一大群接受有创冠状动脉造影（CA）的未经选择的患者的长期预后。人口老龄化，以及接受CA的老年和多病患者数量不断增加，给医疗系统带来了挑战。尽管如此，关于未经选择的接受CA的患者长期预后的年龄相关差异的研究仍然有限。
纳入了来自一个机构的2016年至2022年期间连续接受有创CA的患者。根据预先设定的年龄组（即40 - <60岁、60 - <80岁和≥80岁）对接受CA的患者的预后进行了调查，主要终点是因心力衰竭（HF）再次住院，以及36个月时急性心肌梗死（AMI）和冠状动脉血运重建的风险。
2016年至2022年期间，共纳入7520例接受CA的患者，中位年龄为70岁（平均：69岁）。CAD的患病率（61.9%对71.8%对77.3%；P = 0.001）以及三支血管CAD的患病率（21.0%对31.5%对36.1%）随年龄增加。在36个月时，≥80岁的患者因HF再次住院的发生率最高，其次是60 - <80岁的患者和40 - <60岁的患者（28.4%对23.2%对14.0%；P = 0.001）。因此，与年轻患者（即40 - <60岁）相比，≥80岁的患者因HF相关再次住院的风险最高（≥80岁：HR = 2.205；95%CI 1.884 - 2.579；P = 0.001），其次是60 - <80岁的患者（HR = 1.765；95%CI 1.536 - 2.029；P = 0.001）。在多变量调整后（即≥80岁：HR = 1.265；95%CI 1.049 - 1.524；P = 0.014；60 - <80岁：HR = 1.339；95%CI 1.145 - 1.565；P = 0.001），仍观察到36个月时因HF再次住院的风险增加，并且在左心室射血分数≥35%的患者和无CAD/单支血管CAD证据的患者中尤为明显。相比之下，不同年龄组在36个月时的AMI和冠状动脉血运重建率没有显著差异。
高龄是接受CA的患者因HF再次住院的独立预测因素，但不是长期随访期间AMI和血运重建的独立预测因素。这凸显了优化HF诊断和治疗策略的重要性，特别是在接受CA的老年患者中。
