Abstract：
BACKGROUND: In the elderly people with unprotected left main distal bifurcation lesions (ULMD), percutaneous coronary intervention (PCI) is often selected as first choice treatment strategy because of perioperative high risk of coronary artery bypass graft surgery due to their large number of comorbidities. Also, some recent papers reported that geriatric nutritional risk index (GNRI) is also strongly associated with clinical outcomes after interventional procedures in elderly patients.
OBJECTIVE: We assessed clinical outcomes after PCI for ULMD and the impact of GNRI in elderly patients.
METHODS: We identified 669 non dialysis patients treated with current generation drug-eluting stent for ULMD from MITO registry. We divided the patients to the following 2 groups; elderly group (n = 240, age ≥75) and young group (n = 429, age <75). Additionally, we could calculate GNRI and divided elderly group into 2 group based on the median value of the GNRI. The primary endpoint was all-cause mortality.
RESULTS: All-cause mortality was significantly higher in elderly group [adjusted hazard ratio (HR) 2.37; 95% confidence interval (CI), 1.40-4.02; p = 0.001]. All-cause mortality was significantly higher in low GNRI elderly group compared to other 2 groups (Adjusted HR of elderly with low GNRI: 3.56, 95%CI (1.77-7.14), p < 0.001). Cardiovascular mortality was comparable between two groups. TLR rate was significantly lower in elderly group (adjusted HR 0.57; 95% CI, 0.34-0.97; p = 0.035).
CONCLUSIONS: The elderly had higher all-cause mortality after PCI for ULMD compared to young people. Especially, the elderly with low GNRI were extremely associated with poorer outcomes.
OBJECTIVE: We assessed clinical outcomes after PCI for ULMD and the impact of GNRI in elderly patients.
METHODS: We identified 669 non dialysis patients treated with current generation drug-eluting stent for ULMD from MITO registry. We divided the patients to the following 2 groups; elderly group (n = 240, age ≥75) and young group (n = 429, age <75). Additionally, we could calculate GNRI and divided elderly group into 2 group based on the median value of the GNRI. The primary endpoint was all-cause mortality.
RESULTS: All-cause mortality was significantly higher in elderly group [adjusted hazard ratio (HR) 2.37; 95% confidence interval (CI), 1.40-4.02; p = 0.001]. All-cause mortality was significantly higher in low GNRI elderly group compared to other 2 groups (Adjusted HR of elderly with low GNRI: 3.56, 95%CI (1.77-7.14), p < 0.001). Cardiovascular mortality was comparable between two groups. TLR rate was significantly lower in elderly group (adjusted HR 0.57; 95% CI, 0.34-0.97; p = 0.035).
CONCLUSIONS: The elderly had higher all-cause mortality after PCI for ULMD compared to young people. Especially, the elderly with low GNRI were extremely associated with poorer outcomes.
摘要：
背景：在无保护的左主远端分叉病变（ULMD）的老年人中，经皮冠状动脉介入治疗(PCI)通常被选择为首选治疗策略,因为冠状动脉旁路移植术的围手术期风险较高,因为它们有大量的合并症.此外，最近的一些论文报道,老年营养风险指数(GNRI)也与老年患者介入治疗后的临床结局密切相关.
目的：我们评估老年患者ULMDPCI后的临床结局和GNRI的影响。
方法：我们从MITO注册中确定了669例非透析患者接受了ULMD的当前一代药物洗脱支架治疗。我们将患者分为以下2组：老年组（n=240，年龄≥75）和青年组（n=429，年龄<75）。此外,我们可以计算GNRI，并根据GNRI的中位数将老年组分为2组。主要终点是全因死亡率。
结果：老年组的全因死亡率明显高于[调整后的风险比（HR）2.37；95％置信区间（CI），1.40-4.02；p=0.001]。与其他两组相比，低GNRI老年人组的全因死亡率显着升高（低GNRI老年人的调整后HR：3.56，95CI（1.77-7.14），p<0.001)。两组的心血管死亡率相当。老年组TLR率显着降低（校正HR0.57；95％CI，0.34-0.97；p=0.035）。
结论：与年轻人相比，老年人因ULMDPCI术后全因死亡率较高。尤其是,GNRI较低的老年人与较差的结局极为相关.
目的：我们评估老年患者ULMDPCI后的临床结局和GNRI的影响。
方法：我们从MITO注册中确定了669例非透析患者接受了ULMD的当前一代药物洗脱支架治疗。我们将患者分为以下2组：老年组（n=240，年龄≥75）和青年组（n=429，年龄<75）。此外,我们可以计算GNRI，并根据GNRI的中位数将老年组分为2组。主要终点是全因死亡率。
结果：老年组的全因死亡率明显高于[调整后的风险比（HR）2.37；95％置信区间（CI），1.40-4.02；p=0.001]。与其他两组相比，低GNRI老年人组的全因死亡率显着升高（低GNRI老年人的调整后HR：3.56，95CI（1.77-7.14），p<0.001)。两组的心血管死亡率相当。老年组TLR率显着降低（校正HR0.57；95％CI，0.34-0.97；p=0.035）。
结论：与年轻人相比，老年人因ULMDPCI术后全因死亡率较高。尤其是,GNRI较低的老年人与较差的结局极为相关.
