Clinical characteristics and influence factors of PCI in octogenarians presenting with non-ST-elevation myocardial infarction:hospitalized patients of 80-95 years old
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摘要:
目的 探讨80岁以上老老年急性非ST段抬高型心肌梗死(NSTEMI)患者的临床特征和经皮冠脉介入诊疗术(PCI)决策的影响因素。 方法 纳入2016年7月~2017年6月我院住院诊疗的63例老老年NSTEMI患者与同期71例中青年NSTEMI患者,观察两组患者的临床特征和PCI选择情况,分析影响PCI决策的相关因素。 结果 老老年组患者伴随高血压、肾功能不全、肺部感染、贫血的比例较中青年组升高(P<0.05);与中青年组相比,老老年组选择PCI术的比例明显降低(P<0.05);老老年组在住院期间总体抢救成功率低于中青年组(P<0.05);老老年组选择PCI治疗策略死亡率与中青年组差异无统计学意义(P>0.05),但药物保守治疗死亡率高于中青年组(P<0.05);多因素Logistic回归分析提示年龄、GRACE危险分层、心功能分级、伴随≥3个疾病是影响NSTEMI患者是否行PCI的独立相关因素。 结论 老老年急性NSTEMI患者病情复杂,合并疾病多,选择PCI术的比例下降;PCI有益于提高老老年急性NSTEMI患者的抢救成功率。 -
关键词:
- 老老年 /
- 急性非ST段抬高型心肌梗塞 /
- 冠脉介入诊疗术 /
- 临床特征
Abstract:Objective To investigate the Clinical characteristics and influence factors of PCI in Octogenarians presenting with non-ST-elevation myocardial infarction. Methods We included 63 cases of very elderly patients (≥80 years old) diagnosed with NSTEMI from July 2016 to June 2017 and 71 cases of young patients (< 65 years old) confirmed NSTEMI at the same period. The clinical characteristics and the selection ratio of PCI in two groups were compared. The relevant relevant influence factor of PCI selection were explored. Results Hypertension, renal insufficiency, pulmonary infection and anemia in the elderly patients group was significantly higher than that of young group (P<0.05). The proportion of PCI in the very elderly group was significantly lower than that of young group (P<0.05). The overall rescue success rate in hospital of the very elderly group was significantly lower (P<0.05). No significant difference of mortality was found in the patients who selected PCI in two group (P>0.05). The mortality in the patients who selected conservative medication in the very elderly group was higher than that of young group (P<0.05). Age, GRACE risk stratification, heart function, more than 3 diseases were independent factors of PCI selection in the NSTEMI patients. Conclusion The very elderly patients with acute NSTEMI are often accompany with several diseases. They have low propotion of PCI selection and complex clinical features. PCI is beneficial to improve the rescue success rate of the very elderly patients with acute NSTEMI. -
表 1 两组患者临床特征
临床特征 老老年组(n=65例) 中青年组(n=71例) P 年龄(Mean±SD,岁) 83.5±3.5 54.8±6.9 <0.001 性别(女/男,例) 28/37 8/63 <0.001 高血压(例) 49(75.4%) 34(47.9%) 0.001 糖尿病(例) 31(47.7%) 33(46.5%) 0.887 肾功能不全(例) 20(30.8%) 10(14.1%) 0.019 消化道出血(例) 3(4.6%) 1(1.4%) 0.269 肺部感染(例) 19(29.2%) 4(5.6%) <0.001 贫血(例) 8(12.3%) 2(2.8%) 0.034 住院时间(Mean±SD, d) 16.1±19.2 10.1±8.9 0.019 抢救成功率(例,%) 54(83.1%) 66(93%) 0.074 表 2 PCI选择及不同治疗方案死亡率比较
治疗方案 老老年组 中青年组 χ2 P PCI术比例 39/63(60%) 62/71(87.3%) 13.25 <0.001 死亡率 PCI术组 2/39(5.1%) 3/61(4.9%) 0.02 0.962 药物保守组 10/26(38.5%) 2 /10(20%) 0.943 0.046 表 3 不同危险分层组PIC决择的比较
组别 例数 PCI术(%) 药物保守(%) χ2 P 极高危组 48 89.6 10.4 9.108 0.003 高危组 88 65.9 34.1 表 4 PCI决择相关影响因素分析
因素 回归系数 P OR 95%可信区间 年龄 1.403 0.001 4.067 (1.769~9.351) GRACE危险分层 1.867 0.002 6.466 (1.94~21.56) 心功能分级 0.599 0.007 0.549 (0.36~0.85) 伴随≥3个疾病 0.998 0.002 0.369 (0.193~0.703) -
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