在中国接受初级皮肤冠状动脉干预的75岁以上STEMI患者的患病率和结果
Mengjin Hu1, Xinyue Lang2, Jingang Yang2
1Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
概括
初级穿皮冠状动脉干预 (PCI) 显著降低了老年ST段升高心肌梗塞 (STEMI) 患者的死亡率和主要不良事件. 这种有效的治疗方法在中国实践中仍未得到充分利用.
科学领域:
- 心脏病学 心脏病学
- 老年医学 老年医学
- 干预心脏病学 干预心脏病学
背景情况:
- 高龄患者 (≥75岁) 的ST段升高心肌梗塞 (STEMI) 存在独特的挑战.
- 针对这一群体的最佳反射策略对于改善结果至关重要.
- 在中国老年人群中,初级穿皮冠状动脉干预 (PCI) 的有效性数据有限.
研究的目的:
- 评估75岁及以上的中国STEMI患者中初级PCI的患病率和结果.
- 在这个高危人群中,比较初级PCI与没有再输血的疗效.
- 确定影响老年STEMI患者治疗决策和治疗结果的因素.
主要方法:
- 一个多中心注册中心在2013年至2014年间确定了年龄≥75岁的STEMI患者.
- 主要结局是全因死亡率;次要结局是主要不良心脏和脑血管事件 (MACCE).
- 为了评估治疗效果,计算了危险比率 (HR) 和95%置信区间 (CI).
主要成果:
- 主要PCI在32.9%的符合条件的患者中使用.
- 与没有再输血相比,初级PCI与两年全因死亡率 (18.0%与36.4%) 和MACCE (28.7%与43.5%) 的显著降低有关.
- 这些好处扩展到85岁以上的患者,心脏性休克患者或延迟入院的患者.
结论:
- 主要PCI在降低老年STEMI患者的死亡率和MACCE方面显示出显著的好处,包括非常老和高风险子组.
- 尽管初级PCI有效,但在中国的临床实践中,该患者群体的初级PCI使用率不足.
- 需要进一步努力,以促进中国老年STEMI患者采用初级PCI.
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