背景：患有急性心肌梗死（AMI）的老年人目前是快速增长的人群。然而,其临床表现和结局仍未解决.方法和结果：对268例连续AMI患者的临床特征和1年内主要不良心血管事件（MACE）和全因死亡率的转归进行分析。将≥80岁（80岁以上；n=100）的患者与≤79岁（79岁以下；n=168）的患者进行比较。（1）在80岁以上组和79岁以下组（86％vs.89%；P=0.52）。(2)KillipIII-IV级(P<0.01),住院死亡率（P<0.01），MACE（P=0.03）和全因死亡率（P<0.01）在80岁以上组的发生率高于79岁以下组。(3)在80岁以上的群体中，与非虚弱患者相比,虚弱患者的临床结局明显更差.（4）多因素分析显示，在80岁以上组，KillipIII-IV级与MACE（比值比[OR]=3.51；P=0.02）和全因死亡率（OR=9.49；P<0.01）相关。在80岁以上组，PCI与全因死亡率呈负相关（OR=0.13；P=0.02）。结论：原发性PCI的发生率不随年龄而下降。尽管与年轻患者相比，八十岁/九岁患者的临床表现更严重，短期结局更差，尤其是那些有弱点的人，即使在这些非常老的患者中，早期侵入性策略也可能改善预后。
Background: Older adults with acute myocardial infarction (AMI) are currently a rapidly growing population. However, their clinical presentation and outcomes remain unresolved. Methods and Results: A total of 268 consecutive AMI patients were analyzed for clinical characteristics and outcomes with major adverse cardiovascular events (MACE) and all-cause mortality within 1 year. Patients aged ≥80 years (Over-80; n=100) were compared with those aged ≤79 years (Under-79; n=168). (1) Primary percutaneous coronary intervention (PCI) was frequently and similarly performed in both the Over-80 group and the Under-79 group (86% vs. 89%; P=0.52). (2) Killip class III-IV (P<0.01), in-hospital mortality (P<0.01), MACE (P=0.03) and all-cause mortality (P<0.01) were more prevalent in the Over-80 group than in the Under-79 group. (3) In the Over-80 group, frail patients showed a significantly worse clinical outcome compared with non-frail patients. (4) Multivariate analysis revealed Killip class III-IV was associated with MACE (odds ratio [OR]=3.51; P=0.02) and all-cause mortality (OR=9.49; P<0.01) in the Over-80 group. PCI was inversely associated with all-cause mortality (OR=0.13; P=0.02) in the Over-80 group. Conclusions: The rate of primary PCI did not decline with age. Although octogenarians/nonagenarians showed more severe clinical presentation and worse short-term outcomes compared with younger patients, particularly in those with frailty, the prognosis may be improved by early invasive strategy even in these very old patients.
PDF(Pubmed)