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目的评价年龄对接受急诊冠状动脉介入治疗(PCI)老年急性ST段抬高心肌梗死患者临床预后的影响。方法 221例接受了急诊直接PCI治疗急性ST段抬高心肌梗死患者纳入本研究,根据年龄分为3组:<65岁组(107例)、65～74岁组(74例)和≥75岁组(40例),收集基线资料包括年龄、性别、胸痛时间、心肌梗死部位、术前Killip分级、梗死相关血管、冠脉病变血管支数、支架类型、出院前左心室射血分数(LVEF)、心肌酶峰值、血红蛋白、血肌酐、血糖、冠心病危险因素(吸烟、肥胖、高血压、糖尿病和高血脂),临床随访平均(16.7±11.3)个月(6～38个月),主要不良心脏事件(MACE)发生36例。结果多因素Logistic回归分析显示,出院前LVEF是随访期总MACE发生的独立预测因素(P=0.0057)。在65～74岁组和≥75岁组中单支血管病变所占比例明显低于<65岁组(P=0.0001);而在65～74岁组和≥75岁组中其双支病变、三支病变所占比例高于<65岁组(P=0.0618,P=0.0340)。在65～74岁组和≥75岁组中Killip分级(Ⅱ、Ⅲ、Ⅳ级)的比例明显高于<65岁组(P=0.0052);而在65～74岁组和≥75岁组中LVEF明显低于<65岁组(P=0.0493);在65～74岁组和≥75岁组中高血压的比例明显高于<65岁组(P=0.0162)。随着年龄增长,随访期间MACE发生率明显增高,在<65岁组为10.28%、65～74岁组为16.22%、≥75岁组为32.50%(P=0.0051),差异有统计学意义。结论在接受急诊冠状动脉介入治疗的老年急性ST段抬高心肌梗死患者,MACE发生率随年龄增长而增高,年龄、多支血管病变、Killip分级和LVEF可能影响其预后。
Objective To evaluate the effect of age on the clinical outcome of patients undergoing acute coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction. Methods A total of 221 patients with acute ST-segment elevation myocardial infarction who underwent emergency PCI were enrolled in this study and divided into 3 groups according to their age: <65 years old (107 cases), 65-74 years old (74 cases) and ≥75 years old (N = 40). The baseline data collected included age, sex, duration of chest pain, myocardial infarction, preoperative Killip grading, infarct-related blood vessels, coronary artery vessel count, stent type, left ventricular ejection fraction (LVEF) , Peak of myocardial enzymes, hemoglobin, serum creatinine, blood glucose, risk factors of coronary heart disease (smoking, obesity, hypertension, diabetes and hyperlipidemia). The average clinical follow-up was (16.7 ± 11.3) months Thirty-six cases of cardiac events (MACE) occurred. Results Multivariate Logistic regression analysis showed that LVEF before discharge was an independent predictor of total MACE at follow-up (P = 0.0057). The proportion of single vessel disease in 65-74 years old group and ≥75 years old group was significantly lower than that in <65 years old group (P = 0.0001). However, in 65-74 years old group and ≥75 years old group, The proportions of the three lesions were higher than those of the <65 age group (P = 0.0618, P = 0.0340). The Killip grade (grade II, III, IV) was significantly higher in the 65-74 age group and the ≥75 age group than in the <65 age group (P = 0.0052); in the 65-74 age group and the ≥75 age group The LVEF was significantly lower in patients younger than 65 years (P = 0.0493). The prevalence of hypertension in patients aged 65-74 years and ≥75 years was significantly higher than that in patients <65 years (P = 0.0162). With age, the incidence of MACE was significantly higher during follow-up, with 10.28% in <65 years, 16.22% in 65-74 years and 32.50% in ≥75 years (P = 0.0051). The difference was statistically significant. Conclusions The incidence of MACE in elderly patients with acute ST-segment elevation myocardial infarction who received emergency PCI is higher with age. Age, multivessel disease, Killip classification and LVEF may affect their prognosis.