老年患者经皮冠状动脉介入治疗：单中心经验的临床益处与挑战
Percutaneous coronary intervention in elderly patients: clinical benefits and challenges from single center experience.
作者信息
Rapyan Ani A, Chopikyan Armine S, Jndoyan Zinaida T, Tavaratsyan Ani R, Kocharyan Ani S, Mahrokhian Shant H, Sisakian Hamayak S
机构信息
Department of General and Invasive Cardiology and Internal Diseases, University Hospital 1, Yerevan State Medical University Yerevan 0025, Armenia.
Department of Public Health, Yerevan State Medical University Yerevan 0025, Armenia.
出版信息
Am J Cardiovasc Dis. 2025 Apr 25;15(2):123-130. doi: 10.62347/DGQV8894. eCollection 2025.
OBJECTIVES
Elderly patients who present with acute myocardial infarction are at increased risk for adverse outcomes owing to higher comorbidity burden and complicated coronary anatomy. We evaluated the three-year outcomes following coronary revascularization compared to conservative management among elderly patients presenting with acute myocardial infarction.
METHODS
155 patients over 75 years of age who were admitted for acute myocardial infarction underwent invasive treatment with coronary angioplasty (n=58) or only medical treatment (n=97). The Kaplan-Meier log rank test was used to compare 3-year survival and rehospitalization probability and the Mantel-Cox log rank test was used to compare mean survival time between groups.
RESULTS
In the Invasive treatment group (ITG) cohort, 3-year survival probability was 74.1% as compared to 29.9% in the Conservative treatment group (CTG) cohort (P<0.001). Mean survival time at 3 years of follow-up was 31.50 (95% CI 29.35-33.65) months among ITG patients versus 24.65 (95% CI 22.71-26.59) months among CTG patients (P<0.001). Mean time to rehospitalization at 3 years was 34.05 (95% CI 32.37-35.72) in the ITG cohort compared to 30.03 (95% CI 28.13-31.93) in the CTG cohort (P=0.004).
CONCLUSION
Coronary revascularization among elderly patients with acute myocardial infarction reduces both all-cause mortality and cardiovascular events at 3-year follow-up. However, rates of rehospitalizations remain statistically similar between groups. Moreover, invasive treatment imparted improved rehospitalization probability compared to conservative treatment. This observation can be partially explained by a reduction in the frequency of myocardial infarction among those who underwent invasive treatment. While a thorough clinical assessment is required prior to treatment determination among elderly patients with acute myocardial infarction, coronary revascularization should be strongly considered as an intervention that likely improves overall survival probability.
目的
由于合并症负担较重和冠状动脉解剖结构复杂，老年急性心肌梗死患者出现不良结局的风险增加。我们评估了老年急性心肌梗死患者冠状动脉血运重建与保守治疗相比的三年结局。
方法
155例75岁以上因急性心肌梗死入院的患者接受了冠状动脉血管成形术的侵入性治疗（n = 58）或仅接受药物治疗（n = 97）。采用Kaplan-Meier对数秩检验比较3年生存率和再住院概率，采用Mantel-Cox对数秩检验比较组间平均生存时间。
结果
在侵入性治疗组（ITG）队列中，3年生存概率为74.1%，而保守治疗组（CTG）队列中为29.9%（P<0.001）。ITG患者随访3年的平均生存时间为31.50（95%CI 29.35 - 33.65）个月，而CTG患者为24.65（95%CI 22.71 - 26.59）个月（P<0.001）。ITG队列3年时的平均再住院时间为34.05（95%CI 32.37 - 35.72），而CTG队列中为30.03（95%CI 28.13 - 31.93）（P = 0.004）。
结论
老年急性心肌梗死患者的冠状动脉血运重建可降低3年随访时的全因死亡率和心血管事件。然而，两组间再住院率在统计学上仍相似。此外，与保守治疗相比，侵入性治疗提高了再住院概率。这一观察结果部分可以通过接受侵入性治疗的患者中心肌梗死频率的降低来解释。虽然在确定老年急性心肌梗死患者的治疗方案之前需要进行全面的临床评估，但冠状动脉血运重建应被强烈视为一种可能提高总体生存概率的干预措施。
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