Impact of age on management and outcome of acute coronary syndrome: Observations from the Global Registry of Acute Coronary Events (GRACE)
Impact of age on management and outcome of acute coronary syndrome: Observations from the Global Registry of Acute Coronary Events (GRACE)
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DOI：
10.1016/j.ahj.2004.06.003
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发表时间：
2005-01-01
影响因子：
4.8
通讯作者：
Collet, JP
中科院分区：
文献类型：
--
作者：
Avezum, A;Makdisse, M;Collet, JP
背景 基于证据的心脏治疗在老年患者中没有得到充分利用。我们根据年龄和急性冠脉综合征 (ACS) 类型评估了实践模式、合并症和院内事件发生率的差异。方法我们研究了 14 个国家 102 家医院的 24165 名 ACS 患者，按年龄分层。结果 大约三分之二的患者是男性，但这一比例随着年龄的增长而下降。在老年患者（≥65岁）中，有心绞痛、短暂性脑缺血发作/脑卒中、心肌梗塞（MI）、充血性心力衰竭、冠状动脉搭桥术（CABG）手术、高血压或心房颤动的病史较常见，且延迟就诊和非ST段抬高的MI显着较高。老年患者较少使用阿司匹林、β-阻滞剂、溶栓治疗、他汀类药物和糖蛋白IIb/IIIa抑制剂，而较多使用钙拮抗剂和血管紧张素转换酶抑制剂。普通肝素在年轻患者中的使用频率更高，而低分子量肝素在所有年龄组中的使用情况相似。冠状动脉造影和经皮介入治疗率随着年龄的增长而显着下降。 CABG 手术率在 65-74 岁（8.1%）和 55-6A 岁（7.7%）患者中最高，但在最年轻（4.7%）和最年长（2.7%）组中有所下降。年龄 < 65 岁患者的大出血率为 2-3%，85 岁患者的大出血率为 > 6%。根据基线风险差异进行调整后，医院死亡率随着年龄的增长而增加（比值比：与 < 45 岁的患者相比，大于或等于 85 岁的患者为 15.7）。结论 许多老年 ACS 患者没有接受循证治疗，这凸显了专门针对老年群体的临床试验的必要性，以及加强在这些个体中使用此类疗法的护理质量计划的必要性。
Background Evidence-based cardiac therapies are underutilized in elderly patients. We assessed differences in practice patterns, comorbidities, and in-hospital event rates, by age and type of acute coronary syndrome (ACS).Methods We studied 24165 ACS patients in 102 hospitals in 14 countries stratified by age.Results Approximately two-thirds of patients were men, but this proportion decreased with age. In elderly patients ( greater than or equal to 65 years), history of angina, transient ischemic attack/stroke, myocardial infarction(MI), congestive heart failure, coronary artery bypass graft (CABG) surgery, hypertension or atrial fibrillation were more common, and delay in seeking medical attention and non-ST-segment elevation MI were significantly higher. Aspirin, beta-blockers, thrombolytic therapy, statins and glycoprotein Ilb/Illa inhibitors were prescribed less, while calcium antagonists and angiotensin-converting enzyme inhibitors were prescribed more often to elderly patients. Unfractionated heparin was prescribed more often in young patients, while low-molecular-weight heparins were similarly prescribed across all age groups. Coronary angiography and percutaneous intervention rates significantly decreased with age. The rate of CABG surgery was highest among patients aged 65-74 years (8.1 %) and 55-6A years (7.7%), but reduced in the youngest (4.7%) and oldest (2.7%) groups. Major bleeding rates were,2-3% among patients aged < 65 years, and > 6% in those : 85 years. Hospital-mortality rates, adjusted for baseline risk differences, increased with age (odds ratio: 15.7 in patients greater than or equal to 85 years compared with those < 45 years).Conclusions Many elderly ACS patients do not receive evidence-based therapies, highlighting the need for clinical trials targeted specifically at elderly cohorts, and quality-of-care programs that reinforce the use of such therapies among these individuals.