Comparison of the efficacy of primary percutaneous coronary intervention in super-old and old aged patients in an advanced aging society.

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2024-11-15 DOI:10.1016/j.jjcc.2024.11.002

Akihiro Endo, Tsuyoshi Oda, Kinya Shirota, Shintaro Akashi, Susumu Yamashita, Kazuhiko Uchida, Tetsuro Ohta, Yoshio Nakazawa, Kazuaki Tanabe

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引用次数: 0

Abstract

Background: Current guidelines strongly recommend the application of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction; however, information on its efficacy in super-old patients aged >90 years is inadequate. We compared the efficacy of primary PCI and its clinical outcomes in super-old patients with those of old patients in a super-aging society.

Methods: Shimane Acute Coronary Syndrome (ACS) Registry was a multicenter retrospective cohort study. Consecutive patients with ACS who visited all PCI centers in Shimane Prefecture between January and December 2020 were enrolled. Patients were classified into four age categories: non-old (<65 years), pre-old (65-<75 years), old (75-<90 years), and super-old (≥90 years). Primary endpoints were major adverse cardiovascular events (MACE), including all-cause death, recurrent ACS, any stroke, and hospitalization for worsening heart failure.

Results: In total, 454 patients were enrolled: 99 non-old, 124 pre-old, 181 old, and 50 super-old. The application rate of primary PCI decreased with increased age, with 89 % in old age and 78 % in super-old age (p = 0.042). In-hospital mortality rate was significantly higher in super-old age than in old age (22 % vs. 8 %, p = 0.010), particularly in shock cases (67 % vs. 31 %, p = 0.040); no difference was observed between the two groups in non-shock cases (8 % vs. 4 %, p = 0.259) or in cases that received primary PCI (10 % vs. 6 %, p = 0.232). Landmark analysis revealed that MACE after 30th day did not differ between super-old and old age groups.

Conclusions: In the advanced aging society of Shimane Prefecture, more than half of patients with ACS were aged ≥75 years, with super-old patients aged ≥90 years accounting for 11 % of all patients. In-hospital mortality rate among super-old age patients was lower among those who underwent primary PCI. The prognosis for super-old age patients who were discharged alive was similar to that of old age patients.

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老龄化社会中超高龄和高龄患者经皮冠状动脉介入治疗的疗效比较。

背景：目前的指南强烈建议急性心肌梗死患者应用一级经皮冠状动脉介入治疗（PCI），但有关其在年龄大于 90 岁的超高龄患者中的疗效的信息尚不充分。我们比较了超高龄患者与超高龄社会中老年患者的初级 PCI 疗效及其临床结果：岛根急性冠状动脉综合征（ACS）登记是一项多中心回顾性队列研究。研究对象为 2020 年 1 月至 12 月期间在岛根县所有 PCI 中心就诊的连续 ACS 患者。患者被分为四个年龄段：非老年（结果：非老年患者的平均年龄为 40 岁；老年患者的平均年龄为 40 岁；老年患者的平均年龄为 40 岁）；老年患者的平均年龄为 40 岁：共纳入 454 名患者：99 名非老年患者、124 名老年前期患者、181 名老年患者和 50 名超老年患者。初级 PCI 的应用率随着年龄的增加而降低，老年患者为 89%，超高龄患者为 78%（P = 0.042）。超高龄患者的院内死亡率明显高于高龄患者（22% vs. 8%，p = 0.010），尤其是休克病例（67% vs. 31%，p = 0.040）；在非休克病例（8% vs. 4%，p = 0.259）或接受初级 PCI 的病例（10% vs. 6%，p = 0.232）中，两组之间未观察到差异。地标分析显示，超高龄组和高龄组在第30天后的MACE没有差异：结论：在岛根县的高龄化社会中，半数以上的 ACS 患者年龄≥75 岁，其中年龄≥90 岁的超高龄患者占患者总数的 11%。超高龄患者的院内死亡率在接受初级 PCI 治疗的患者中较低。超高龄患者出院后的预后与高龄患者相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.