Predictors of long-term (10-year) mortality postmyocardial infarction: Age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project
Predictors of long-term (10-year) mortality postmyocardial infarction: Age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project
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DOI：
10.1016/j.jjcc.2014.06.001
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发表时间：
2015-03-01
影响因子：
2.5
通讯作者：
Gilutz, Harel
中科院分区：
文献类型：
--
作者：
Plakht, Ygal;Shiyovich, Arthur;Gilutz, Harel
背景：心血管疾病是老年人死亡的主要原因。过去几十年来，急性心肌梗死 (AMI) 患者治疗方面的医学进步提高了患者的生存率并延长了预期寿命。随着 AMI 短期生存率的提高，更多的注意力开始转向了解和改善长期结局。 目的：评估“现实世界”患者中 AMI 后长期（长达 10 年）预后因素与年龄相关的变化，重点是改善老年患者的风险分层。方法：根据年龄组对 2763 名连续 AMI 患者进行回顾性分析：65 岁（n = 1533）。数据是从医院的计算机系统收集的。主要结局是出院后 10 年全因死亡率。结果：老年患者中女性、非 ST 段抬高 AMI 和大多数合并症的发生率较高，而侵入性治疗的发生率较低。在随访期间，老年组的死亡率高于年轻组（69.7% vs 18.6%）。交互多变量模型中包含的一些参数与年轻组的结果有更强的相关性（低钠血症、贫血、酗酒或吸毒成瘾、恶性肿瘤、肾脏疾病、既往心肌梗死和侵入性干预），而其他参数则在老年组中具有更强的预测因子（年龄较大、左主干冠状动脉或三支血管疾病以及神经系统疾病）。年轻组和老年组的多变量模型的 c 统计值分别为 0.75 和 0.74，交互模型的 c 统计值为 0.86。结论：可以通过简单、易于获取的临床信息来预测年轻和老年患者 AMI 后的长期死亡率。大多数预测因素与死亡率的关联在年轻患者中更强。这些预测因子可用于优化患者护理，以降低死亡率。 (C) 2014 年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Cardiovascular diseases are the leading cause of death in elderly people. Over the past decades medical advancements in the management of patients with acute myocardial infarction (AMI) led to improved survival and increased life expectancy. As short-term survival from AMI improves, more attention is being shifted toward understanding and improving long-term outcomes.Aim: To evaluate age-associated variations in the long-term (up to 10 years) prognostic factors following AMI in "real world" patients, focusing on improving risk stratification of elderly patients.Methods: A retrospective analysis of 2763 consecutive AMI patients according to age groups: 65 years (n = 1533). Data were collected from the hospital's computerized systems. The primary outcome was 10-year postdischarge all-cause mortality.Results: Higher rates of women, non-ST-elevation AMI, and most comorbidities were found in elderly patients, while the rates of invasive treatment were lower. During the follow-up period, mortality rate was higher among the older versus the younger group (69.7% versus 18.6%). Some of the parameters included in the interaction multivariate model had stronger association with the outcome in the younger group (hyponatremia, anemia, alcohol abuse or drug addiction, malignant neoplasm, renal disease, previous myocardial infarction, and invasive interventions) while others were stronger predictors in the elderly group (higher age, left main coronary artery or three-vessel disease, and neurological disorders). The c-statistic values of the multivariate models were 0.75 and 0.74 in the younger and the elder groups, respectively, and 0.86 for the interaction model.Conclusions: Long-term mortality following AMI in young as well as elderly patients can be predicted from simple, easily accessible clinical information. The associations of most predictors and mortality were stronger in younger patients. These predictors can be used for optimizing patient care aiming at mortality reduction. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.