背景:与年轻患者相比,老年人接受NSTEMI侵入性冠状动脉造影(ICA)的频率较低。我们描述护理,ICA数据,在当代和地理上不同的队列中,按年龄划分的NSTEMI的住院和30天结局。
方法:前瞻性队列研究,包括来自59个国家287个中心的2947例NSTEMI患者,按年龄分层(≥75岁,n=761)。基于12项指南推荐的护理干预措施评估了护理质量,以及在ICA上收集的数据。结果包括在医院急性心力衰竭,心源性休克,重复心肌梗死,中风/短暂性脑缺血发作,BARC≥3型出血和死亡,以及30天的死亡率。
结果:年龄≥75岁的患者,与年轻患者相比,报告中合并症和口服抗凝处方的患病率较高(22.4%vs7.6%,p<0.001)。老年患者接受ICA的频率低于年轻患者(78.6%vs90.6%,p<0.001),记录的原因更多是高龄,合并症或虚弱。在那些接受了ICA的人中,老年患者更频繁地表现出3血管,与年轻患者相比,4血管和/或左主干冠状动脉疾病(49.7%vs34.1%,p<0.001),但接受血运重建的频率较低(63.6%对76.9%,p<0.001)。老年患者院内急性心力衰竭的发生率较高(15.0%vs8.4%,p<0.001)和出血(2.8%vs1.3%,p=0.006),以及住院和30天死亡率(3.4%和1.3%,p<0.001;4.8%对1.7%,p<0.001;分别),比年轻患者。
结论:年龄≥75岁的NSTEMI患者,与年轻患者相比,不太频繁地接受ICA和指南推荐的护理,短期结果更差。
BACKGROUND: Older people less frequently receive invasive coronary angiography (ICA) for NSTEMI than younger patients. We describe care, ICA data, and in-hospital and 30-day outcomes of NSTEMI by age in a contemporary and geographically diverse cohort.
METHODS: Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by age (≥75 years, n = 761). Quality of care was evaluated based on 12 guideline-recommended care interventions, and data collected on ICA. Outcomes included in hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack, BARC Type ≥3 bleeding and death, as well as 30-day mortality.
RESULTS: Patients aged ≥75 years, compared with younger patients, at presentation had a higher prevalence of comorbidities and oral anticoagulation prescription (22.4% vs 7.6%, p < 0.001). Older patients less frequently received ICA than younger patients (78.6% vs 90.6%, p < 0.001) with the recorded reason more often being advanced age, comorbidities or frailty. Of those who underwent ICA, older patients more frequently demonstrated 3-vessel, 4-vessel and/or left main stem coronary artery disease compared to younger patients (49.7% vs 34.1%, p < 0.001) but less frequently received revascularisation (63.6% vs 76.9%, p < 0.001). Older patients experienced higher rates of in-hospital acute heart failure (15.0% vs 8.4%, p < 0.001) and bleeding (2.8% vs 1.3%, p = 0.006), as well as in-hospital and 30-day mortality (3.4% vs 1.3%, p < 0.001; 4.8% vs 1.7%, p < 0.001; respectively), than younger patients.
CONCLUSIONS: Patients aged ≥75 years with NSTEMI, compared with younger patients, less frequently received ICA and guideline-recommended care, and had worse short-term outcomes.