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目的研究70岁以上非 ST 段抬高的急性冠状动脉综合征(NSTEACS)患者的临床特点及治疗现状。方法按统一方案登记因 NSTEACS 入院的患者,记录患者临床特征、药物及干预治疗措施、院内事件。将≥70岁和<70岁的患者分为2组进行单因素分析。结果我国共注册NSTEACS 患者2294例。其中≥70岁患者占27.3%(626例),87.5%为不稳定心绞痛,95.4%伴心电图异常。既往高血压、心肌梗死、卒中及心力衰竭病史分别为62.9%、28.1%、10.2%和11.7%。住院期间转换酶抑制剂治疗率显著高于<70岁组(P<0.01);而β受体阻滞剂及调血脂药治疗率低于<70岁组(P<0.05)。硝酸酯药及抗血小板制剂、钙拈抗剂的应用差异无统计学意义。经皮冠状动脉介入(PCI)及冠状动脉旁路移植术(CABG)治疗显著低于<70岁组(P<0.01)。死亡及心力衰竭发生率高于<70岁患者(P<0.01),事件率分别为2.6%、11.7%。结论我国 NSTEACS≥70岁患者既往陈旧性心肌梗死、脑卒中、高血压和心衰病史多,住院期间 PCI、CABG 干预治疗率低,死亡率及心力衰竭发生高。
Objective To investigate the clinical features and treatment status of patients with non-ST segment elevation acute coronary syndrome (NSTEACS) over the age of 70 years. Methods According to the unified protocol, patients admitted to hospital for NSTEACS were enrolled. The clinical characteristics, drugs, interventions and hospital events were recorded. Patients ≥70 years and <70 years were divided into two groups for univariate analysis. Results 2294 cases of NSTEACS were enrolled in our country. 27.3% (626 cases) of patients ≥70 years of age, 87.5% of unstable angina pectoris, 95.4% with ECG abnormalities. Previous histories of hypertension, MI, stroke and heart failure were 62.9%, 28.1%, 10.2% and 11.7%, respectively. The rate of conversion enzyme inhibitor treatment during hospitalization was significantly higher than that of <70 years old (P <0.01), while that of β-blockers and blood lipid lowering drugs was lower than that of <70 years old group (P <0.05). No significant difference was found in the application of nitrates and antiplatelet agents and calcium antagonists. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were significantly lower than those of <70 years old (P <0.01). The incidence of death and heart failure was higher than that of patients <70 years old (P <0.01). The incident rates were 2.6% and 11.7% respectively. Conclusions The history of old myocardial infarction, stroke, hypertension and heart failure in Chinese patients with NSTEACS≥70 years old is high. During the hospitalization, the intervention rate of PCI and CABG is low, and the mortality and heart failure are high.