80岁及以上老年非ST段抬高型急性冠脉综合征患者侵入性与保守治疗效果评价的回顾性分析

A retrospective analysis of efficacy of invasive and conservative treatment in patients aged 80 years and older with non-ST-seg-ment elevation acute coronary syndrome

中文关键词: 老年  不稳定性心绞痛  非ST段抬高型心肌梗死  经皮冠状动脉介入治疗  保守治疗

英文关键词: elderly  unstable angina  non-ST-segment elevation myocardial infarction  percutaneous coronary interven-tion  conservative management

中文摘要:

      目的 本研究旨在比较80岁及以上非ST段抬高型急性冠脉综合征(NSTEACS)患者侵入性治疗与保守治疗的有效性和安全性.方法 本研究回顾性纳入了 220例于2019年1月-2021年12月间在复旦大学附属华东医院心血管内科住院期间被诊断为不稳定性心绞痛或急性非ST段抬高型心肌梗死的患者,比较侵入性治疗组和保守治疗组患者的预后.主要终点为全因死亡率,次要终点为不良事件发生率,包括因非致死性心肌缺血、心律失常、心力衰竭或出血而再次入院.结果 220例患者中,131例患者(59.5％)接受了早期侵入性治疗.相较于侵入治疗组,保守治疗组患者死亡率的风险比(HR)为5.52(95％CI:1.80～16.92,P=0.0019),且保守治疗组的不良事件发生率更高(HR 2.96,95％CI:1.51～5.82,P=0.0057).然而,在比较完全血运重建组与仅罪犯血管的血运重建组预后时,2组死亡率或不良事件发生率HR没有显著差异.结论 对于80岁及以上的非ST段抬高型急性冠脉综合征患者,早期侵入性治疗可以有效减少死亡率及因心肌缺血、心律失常、心力衰竭的再入院率.在冠状动脉介入治疗策略的选择方面,可以考虑仅进行罪犯血管的血运重建.

英文摘要:

      Objective To compare the efficacy and safety of invasive versus conservative treatment in patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome(NSTEACS).Methods A total of 220 patients diag-nosed with unstable angina pectoris or NSTEMI during hospitalization in Department of Cardiovascular Medicine of Huadong Hospital Affiliated to Fudan University from January 2019 to December 2021 were retrospectively included.The prognosis of pa-tients in the invasive treatment group and the conservative treatment group was compared.The primary endpoint was all-cause mortality,and the secondary endpoint was the occurrence of adverseevents,including readmission due to non-fatal myocardial ischemia,arrhythmia,heart failure,or bleeding.Results Among the 220 patients included,131 ones(59.5％)received ear-ly invasive treatment.Compared with the invasive treatment group,the hazard ratio(HR)for mortality in the conservative treatment group was 5.52(95％CI:1.80-16.92,P=0.0019),and the incidence of adverse events was higher in the conser-vative treatment group(HR 2.96,95％CI:1.51-5.82,P=0.0057).However,when comparing the prognosis between the complete revascularization group and the revascularization onlyin culprit blood vessel group,there was no significant difference in the HR of themortality or incidence of adverse event between the two groups.Conclusions For patients aged 80 years and older with NSTEACS,early invasive management can effectively reduce mortality and the rate of readmissions due to myocardi-al ischemia,arrhythmia and heart failure.In the selection of coronary intervention treatment strategies,it may be considered to perform revascularization only in culprit blood vessels.