Gjuras Karlo, Jurin Ivana, Jurin Hrvoje, Margetić Eduard, Skorić Boško, Bulum Joško, Hadžibegović Irzal, Zeljković Ivan, Pavlov Marin, Manola Šime, Marić Bešić Kristina
Department of Family Medicine, Health Centre Bjelovar-Bilogora County, 43000 Bjelovar, Croatia.
Department of Cardiovascular Medicine, Dubrava University Hospital, 10000 Zagreb, Croatia.
Medicina (Kaunas). 2025 Aug 9;61(8):1436. doi: 10.3390/medicina61081436.
: Older patients with ACS are less frequently treated with an invasive strategy, which may negatively impact their survival. This study aimed to investigate treatment approaches in elderly ACS patients and compare outcomes between invasively and conservatively treated groups. : This retrospective study included consecutive patients aged 80 or older who presented with ACS at two tertiary institutions from November 2018 to October 2023. The invasive group consisted of patients who underwent percutaneous or surgical revascularization. The conservative strategy was defined as guideline-directed medical therapy only. The primary outcome was all-cause mortality during the six-month follow-up. Secondary outcomes were recurrent MI and CVI. : Among 670 ACS patients with a median age of 83 years (81-86) and 50.6% women, 429 (64%) were treated with an invasive strategy, and 241 (36%) were treated with a conservative strategy. A total of 176 (26%) patients died during the six-month follow-up period, with significantly higher mortality observed in the conservatively treated group compared to the invasively treated group (ACS: 37.8% vs. 19.3%, < 0.001; STEMI: 49.4% vs. 26.8%, < 0.001; NSTE-ACS: 32.1% vs. 10.9%, < 0.001). Recurrent MI was documented in 2.5% of patients, while CVI occurred in 1.2%, with no difference between the treatment groups. Multivariable regression analysis identified invasive strategy (HR = 0.48; 95% CI: 0.33-0.71; < 0.001) as a positive predictor of six-month survival in ACS patients. : The invasive treatment strategy was associated with lower mortality in older ACS patients, regardless of the type of ACS. The incidence of recurrent MI and CVI did not differ between groups treated with different therapeutic approaches.
老年急性冠状动脉综合征（ACS）患者接受侵入性治疗策略的频率较低，这可能会对他们的生存产生负面影响。本研究旨在调查老年ACS患者的治疗方法，并比较侵入性治疗组和保守治疗组的结局。：这项回顾性研究纳入了2018年11月至2023年10月期间在两家三级医疗机构就诊的80岁及以上的连续ACS患者。侵入性治疗组包括接受经皮或外科血管重建术的患者。保守治疗策略定义为仅采用指南指导的药物治疗。主要结局是六个月随访期间的全因死亡率。次要结局是复发性心肌梗死（MI）和心血管事件（CVI）。：在670例ACS患者中，中位年龄为83岁（81 - 86岁），女性占50.6%，429例（64%）接受了侵入性治疗策略，241例（36%）接受了保守治疗策略。在六个月的随访期内，共有176例（26%）患者死亡，保守治疗组的死亡率显著高于侵入性治疗组（ACS：37.8%对19.3%，<0.001；ST段抬高型心肌梗死（STEMI）：49.4%对26.8%，<0.001；非ST段抬高型急性冠状动脉综合征（NSTE - ACS）：32.1%对10.9%，<0.001）。2.5%的患者记录有复发性MI，1.2%的患者发生CVI，治疗组之间无差异。多变量回归分析确定侵入性治疗策略（风险比（HR）=0.48；95%置信区间（CI）：0.33 - 0.71；<0.001）是ACS患者六个月生存的阳性预测因素。：侵入性治疗策略与老年ACS患者较低的死亡率相关，无论ACS的类型如何。不同治疗方法治疗的组之间复发性MI和CVI的发生率没有差异。
