Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group.
Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group.
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DOI：
10.1161/jaha.115.003027
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发表时间：
2016-06-27
影响因子：
5.4
通讯作者：
Wragg A
中科院分区：
文献类型：
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作者：
Bromage DI;Jones DA;Rathod KS;Grout C;Iqbal MB;Lim P;Jain A;Kalra SS;Crake T;Astroulakis Z;Ozkor M;Rakhit RD;Knight CJ;Dalby MC;Malik IS;Mathur A;Redwood S;MacCarthy PA;Wragg A
ST段抬高型心肌梗死在80多岁老人中越来越常见，该队列的最佳处理方法尚不确定。本研究旨在描述经皮冠状动脉介入治疗ST段抬高型心肌梗死的80岁高龄患者的预后。我们分析了2005年至2011年间在英国伦敦8个三级心脏中心接受经皮冠状动脉介入治疗的10249例ST段抬高型心肌梗死患者。主要终点为中位随访3年的全因死亡率。80岁以上患者1051例，占10.3%，平均年龄84.2岁，随着研究时间的推移比例有所增加（P=0.04）。与年龄<80岁的患者相比，80岁老人的住院死亡率（7.7% vs 2.4%， P<0.0001）和长期死亡率（51.6% vs 12.8%， P<0.0001）均增加，在完全调整模型中，年龄是死亡率的独立预测因子（风险比1.07,95% CI 1.07 - 1.09， P<0.0001）。时间分层分析显示，随着时间的推移，队列越来越老，越来越复杂。然而，随着时间的推移，80多岁老人的长期死亡率保持不变，这可能归因于经皮冠状动脉介入技术的改进，包括显著提高桡动脉通路率和降低出血并发症。与出血并发症相关的变量在80多岁人群和年轻人群中相似。在这项大型登记中，与年轻人群相比，接受初级经皮冠状动脉介入治疗的80多岁老人的并发症和死亡率更高。随着时间的推移，接受初级经皮冠状动脉介入治疗的80多岁老人的数量、年龄和复杂性增加。然而，住院结果是合理的，长期死亡率是稳定的。
ST‐segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention. We analyzed 10 249 consecutive patients with ST‐segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all‐cause mortality at a median follow‐up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In‐hospital mortality (7.7% vs 2.4%, P<0.0001) and long‐term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07–1.09, P<0.0001). Time‐stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long‐term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts. In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in‐hospital outcomes were reasonable, and long‐term mortality rates were static.