与< 80岁急性冠状动脉综合征的老年患者相比，冠状动脉介入治疗对80岁和90岁患者住院死亡率的影响

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-07-01 DOI:10.1016/j.cjco.2025.04.006

Jayant Ravindran BSc Med, MBBS, MMed , David Brieger MBBS, PhD , Karice Hyun PhD , Vincent Chow MBBS, PhD , Andy Yong MBBS, PhD , Leonard Kritharides MBBS, PhD , Austin Chin Chwan Ng MBBS, BSc Med, MMed

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引用次数: 0

摘要

考虑到澳大利亚人口老龄化，老年患者出现急性冠脉综合征（ACS），其管理在过去20年可能发生了变化。方法回顾性观察研究来自新南威尔士州全州入院患者数据收集数据库，收集2002年1月至2021年12月期间因ACS住院的年龄≥65岁的患者。患者分为3个年龄组：65-79岁，80-89岁，≥90岁。评估ACS、冠状动脉造影（CA）、经皮冠状动脉介入治疗（PCI）和住院死亡率的时间趋势。多变量分析用于调整死亡率分析中的基线概况和入院年份。结果研究队列包括118,608例患者(56.7%年龄在65-79岁之间[n = 67,211]；34.1%年龄在80-89岁[n = 40,452]；9.2%年龄≥90岁[n = 10,945])。与老年组相比，65-79岁的男性患者比例更高，缺血性心脏病、糖尿病、吸烟史、既往PCI和/或手术搭桥血运重建术和肥胖的发生率更高。心力衰竭、慢性肺部和肾脏疾病以及痴呆在年龄较大的人群中更为常见。按比例，st段抬高型心肌梗死随时间减少，而非st段抬高型心肌梗死发生率增加。尽管老年组的CA较少，但≥80岁的CA患者的PCI率较高。多变量分析显示，与2006年或更早的时间相比，2017年或更晚入院的人群的住院死亡率下降了49%；与老年人相比，年轻人的死亡率分别下降了55.4%、52.5%和44.6%。与65-79岁组相比，≥90岁组的住院死亡校正几率高3.1倍。结论在过去的20年里，随着冠状动脉介入率的增加，老年人住院死亡率下降，但老年患者在ACS后的预后仍然较差。

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Impact of Coronary Intervention on In-Hospital Mortality in Octogenarians and Nonagenarians, Compared to Elderly Patients Aged < 80 Years with Acute Coronary Syndromes

Background

Given that the Australian population is aging, with older patients presenting with acute coronary syndrome (ACS), its management over the past 20 years is likely to have changed.

Methods

Retrospective observational study from the New South Wales statewide Admission Patient Data Collection database of those aged ≥ 65 years hospitalized for ACS between January 2002 and December 2021. Patients were stratified into 3 age groups: 65-79 years, 80-89 years, ≥ 90 years). Temporal trends of ACS, coronary angiogram (CA), and percutaneous coronary intervention (PCI) and in-hospital mortality were evaluated. Multivariable analysis was used to adjust for baseline profiles and year of admission in mortality analysis.

Results

The study cohort comprised 118,608 patients (56.7% aged 65-79 years [n = 67,211]; 34.1% aged 80-89 years [n = 40,452]; 9.2% aged ≥ 90 years [n = 10,945]). Those aged 65-79 years, compared to older groups, had proportionally more male patients, with higher rates of ischemic heart disease, diabetes, smoking history, prior PCI and/or surgical bypass revascularization, and obesity. Heart failure, chronic pulmonary and renal disease, and dementia were more common in the older age groups. Proportionally, ST-elevation myocardial infarction decreased over time, whereas non-ST-elevation myocardial infarction rates increased. Although fewer CAs were performed in the older age groups, PCI rates in those who had CA were higher in those aged ≥ 80 years. Multivariable analysis showed that in-hospital mortality fell 49% in the group admitted in 2017 or later, vs in 2006 or earlier; for the younger, vs the older age groups, mortality fell by 55.4%, 52.5%, and 44.6%, respectively. The group aged ≥ 90 years had 3.1-fold higher adjusted odds of in-hospital death, compared to the group aged 65-79 years.

Conclusions

Over the past 2 decades, with increasing rates of coronary intervention, rates of in-hospital mortality in the elderly decreased, but older patients continue to have poorer outcomes following ACS.

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