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解放军总医院医学创新研究部、国家老年疾病临床医学研究中心(解放军总医院)、解放军总医院第六医学中心心血管病医学部
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
谭静,张迎花,司瑾,左雪冰,李静.75岁及以上急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗状况及预后[J].中华老年多器官疾病杂志,2022,21(8):597~601
75岁及以上急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗状况及预后
Status and prognosis of acute ST-elevation myocardial infarction in elder patients 75 years of age or older after percutaneous coronary intervention
投稿时间:2022-02-07  
DOI:10.11915/j.issn.1671-5403.2022.08.128
中文关键词:  老年人;ST段抬高型心肌梗死;经皮冠状动脉介入治疗;病死率
英文关键词:aged; ST-elevation myocardial infarction; percutaneous coronary intervention; mortality Corresponding author:LI Jing, E-mail:shpxbb@sina.com〖FL
基金项目:
作者单位E-mail
谭静 首都医科大学宣武医院 心脏内科,,北京 100053 shpxbb@sina.comstatus 
张迎花 首都医科大学宣武医院 心脏内科,,北京 100053 shpxbb@sina.comstatus 
司瑾 首都医科大学宣武医院 心脏内科,,北京 100053 shpxbb@sina.comstatus 
左雪冰 首都医科大学宣武医院 心脏内科,,北京 100053 shpxbb@sina.comstatus 
李静 首都医科大学宣武医院 老年医学科,北京 100053 shpxbb@sina.comstatus 
摘要点击次数: 33
全文下载次数: 44
中文摘要:
      目的 分析≥75岁急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)的状况及预后。方法 回顾性分析2009年4月至2018年12月首都医科大学宣武医院心脏内科收治的425例≥75岁急性STEMI患者的临床资料,根据住院期间治疗方式分为急诊PCI组112例、择期PCI组80例和保守治疗组233例。收集患者基本临床资料、住院期间治疗方式及并发症发生情况等,每1~3个月进行门诊或电话随访观察预后,随访至2019年12月。采用SPSS 26.0统计软件进行数据分析。采用多因素logistic回归分析影响治疗策略选择的因素。绘制Kaplan-Meier生存曲线,采用log-rank检验分析各组生存率差异。结果 ≥75岁急性STEMI患者行急诊冠状动脉造影和急诊PCI的比例分别为31.5%(134/425)和26.4%(112/425)。多因素logistic回归分析显示发病至就诊时间(OR=0.841,95%CI 0.792~0.893;P<0.001)和心功能Killip≥Ⅱ级(OR=0.440,95%CI 0.238~0.814;P<0.01)是影响急诊PCI的独立因素;年龄(OR=1.259,95%CI 1.129~1.405;P<0.001)、肌酐清除率(OR=0.972,95%CI 0.952~0.993;P<0.01)和心功能Killip≥Ⅱ级(OR=2.958,95%CI 1.420~6.163;P<0.01)是影响择期PCI的独立因素。急诊PCI、择期PCI和保守治疗组院内全因死亡率分别为13.4%(15/112)、3.8%(3/80)和18.9%(44/233),保守治疗组全因病死率显著高于择期PCI组,差异有统计学意义(P<0.05)。择期PCI组心室颤动的比例显著低于急诊PCI组,差异有统计学意义[0.0%(0/80)和8.9%(10/112);P<0.05]。中位随访时间31(12,53)个月,保守治疗组累积生存率显著低于急诊PCI组和择期PCI组[44.6%(104/233)和71.4%(80/112),78.8%(63/80);均P<0.05]。结论 ≥75岁STEMI患者急诊PCI治疗比例较低,发病至就诊时间、高龄、心肾功能不全与患者治疗策略选择相关。接受PCI治疗的患者近期和远期存活率显著高于药物保守治疗者。
英文摘要:
      Objective To analyze the status of percutaneous coronary intervention (PCI) and prognosis in patients aged 75 years or older with acute ST-elevation myocardial infarction (STEMI). Methods The clinical data of 425 acute STEMI patients aged≥75 years admitted to our hospital from April 2009 to December 2018 were retrospectively analyzed. According to their treatment during hospitalization, they were divided into emergency PCI group (n=112), elective PCI group (n=80) and conservative treatment group (n=233). Their basic clinical data, treatment during hospitalization and incidence of complications were collected. All patients were followed up regularly every 1-3 months by clinical visits or phone interview till December 2019. SPSS statistics 26.0 was used for data analysis. Multivariate logistic regression was used to analyze the factors influencing the clinical decision-making strategy. Kaplan-Meier survival curve was drawn, and log-rank test was employed to analyze the differences in survival rates among the groups. Results The rates of emergency coronary angiography and emergency PCI were 31.5% (134/425) and 26.4% (112/425), respectively for the acute STEMI patients aged ≥75 years. Multivariate logistic regression analysis revealed that symptom-onset-to-treatment time (OR=0.841,95%CI 0.792-0.893;P<0.001) and initial Killip class ≥Ⅱ (OR=0.440,95%CI 0.238-0.814;P<0.01) were independent influencing factors of emergency PCI; age (OR=1.259,95%CI 1.129-1.405;P<0.001), creatinine clearance rate (OR=0.972,95%CI 0.952-0.993;P<0.01) and initial Killip class≥Ⅱ (OR=2.958,95%CI 1.420-6.163;P<0.01) were independent factors for elective PCI. The in-hospital all-cause mortality was 13.4% (15/112), 3.8% (3/80) and 18.9% (44/233), respectively in the emergency PCI, elective PCI and conservative treatment groups, with significant differences among them (P<0.05). The incidence of ventricular fibrillation was statistically lower in the elective PCI group than the emergency PCI group [0.0% (0/80) vs 8.9% (10/112), P<0.05]. During a median follow-up of 31 (12~53) months, the cumulative survival rate was remarkably lower in the conservative treatment group than the emergency and elective PCI groups [44.6% (104/233) vs 71.4% (80/112), 78.8% (63/80); all P<0.05]. Conclusion Elderly STEMI patients aged ≥75 years have a lower rate of undergoing emergency PCI. Symptom-onset-to-treatment time, advanced age, impaired cardiac and renal functions are associated with clinical decision-making strategy. The patients undergoing PCI will achieve significantly higher short- and long-term survival rates than those taking conservative management.
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