衰老对急性冠状动脉综合征的影响:基于EHR的分析
Quinten P Hoogervorst1, Charlotte E P Siegers1, Jan van Ramshorst1
1Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
概括
侵入性策略可能会改善老年急性冠状动脉综合征 (ACS) 患者的结果,包括非老年人. 这项研究发现,老年ACS患者的侵入性治疗有助于改善存活率的趋势,90岁及以上患者有显著的益处.
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:
- 八十岁和非六十岁人群中急性冠状动脉综合征 (ACS) 的发生率正在增加,但仍未得到报道.
- 现有的数据往往低估了患有ACS的非常老年患者的独特特征和结果.
- 在老年人群中ACS的最佳治疗策略需要进一步澄清.
研究的目的:
- 描述80岁及以上ACS患者的患者人口统计和临床概况.
- 为了比较不同年龄小组 (80-84,85-89,90+) 的初始侵入性策略与最佳医疗治疗 (OMT) 的结果.
- 评估在非老年人中对ACS的侵入性治疗的安全性和有效性.
主要方法:
- 对2020年至2023年期间连续入院的ACS患者的回顾性分析.
- 电子健康记录 (EHR) 数据提取患者特征和结果.
- 进行了多变量分析,比较了三个年龄组的侵入性策略与OMT:80-84岁,85-89岁和90岁以上.
主要成果:
- 总共分析了1036名80岁以上的ACS患者,其中非老年人显示女性占主导地位,血管造影/PCI率较低.
- 在所有年龄层,在侵袭和OMT组之间没有观察到并发症率 (出血,CVA,ICU入院) 的显著差异.
- 3个月后,在80-84岁和85-89岁的年龄组中,通过侵入性策略观察到改善全因死亡率的趋势,在90岁以上的年龄组中观察到显著的益处 (HR 0.16).
结论:
- 与年轻的老年人 (80-89岁) 相比,患有ACS的非老年人表现出明显的特征.
- 与80-84 (4%) 和85-89 (10%) 组相比,非老年人 (15%) 的三十天死亡率显著更高.
- 这项单一中心,全员研究表明,仔细选择患者可以使入侵策略安全有效的八十岁和nonagenarians与ACS.
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