CAJ | 학술논문

背景：冠状动脉药物涂层支架置入治疗是急性ST段抬高型心肌梗死的最佳治疗方法，但由于老年患者合并危险因素较多，死亡率随着年龄的增加而增高。目的：观察不同年龄ST段抬高型心肌梗死患者置入国产雷帕霉素药物涂层支架的临床特征及住院期间预后特点。方法：回顾性分析307例因初发ST段抬高型心肌梗死接受急诊冠状动脉国产雷帕霉素药物涂层支架置入治疗患者的临床资料，根据年龄分为3组，非老年组(<65岁，n=175)、普通老年组(65-74岁，n=83)、高龄组(≥75岁，n=49)，比较3组住院期间的临床特征、病死率及联合心血管事件发生情况。结果与结论：与非老年组相比，普通老年组、高龄组女性比例较高(P <0.05)，吸烟者较少(P <0.05)，既往高血压病史比例增加(P <0.05)，血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平降低(P <0.05)。随着年龄的增长，血清肌酐水平逐渐升高，恶性心律失常发生率与住院期间心源性死亡发生率逐渐增加。与非老年组、普通老年组比较，高龄组心功能Kilip分级≥Ⅱ级比例、3支或左主干病变比例较高(P <0.05)，成功再灌注率下降(P <0.05)，急性充血性心力衰竭、联合心血管事件的发生率较高(P <0.05)。多因素Logistic回归分析显示，年龄是患者住院期间病死率的独立危险因素(P <0.01)。
배경：관상동맥약물도층지가치입치료시급성ST단태고형심기경사적최가치료방법，단유우노년환자합병위험인소교다，사망솔수착년령적증가이증고。목적：관찰불동년령ST단태고형심기경사환자치입국산뢰파매소약물도층지가적림상특정급주원기간예후특점。방법：회고성분석307례인초발ST단태고형심기경사접수급진관상동맥국산뢰파매소약물도층지가치입치료환자적림상자료，근거년령분위3조，비노년조(<65세，n=175)、보통노년조(65-74세，n=83)、고령조(≥75세，n=49)，비교3조주원기간적림상특정、병사솔급연합심혈관사건발생정황。결과여결론：여비노년조상비，보통노년조、고령조녀성비례교고(P <0.05)，흡연자교소(P <0.05)，기왕고혈압병사비례증가(P <0.05)，혈홍단백、총담고순、삼선감유、저밀도지단백담고순수평강저(P <0.05)。수착년령적증장，혈청기항수평축점승고，악성심률실상발생솔여주원기간심원성사망발생솔축점증가。여비노년조、보통노년조비교，고령조심공능Kilip분급≥Ⅱ급비례、3지혹좌주간병변비례교고(P <0.05)，성공재관주솔하강(P <0.05)，급성충혈성심력쇠갈、연합심혈관사건적발생솔교고(P <0.05)。다인소Logistic회귀분석현시，년령시환자주원기간병사솔적독립위험인소(P <0.01)。
BACKGROUND:Coronary drug-eluting stent implantation is the best treatment for acute ST-segment elevation myocardial infarction, but because of many combined risk factors in elderly patients, the mortality rate is increased with aging. OBJECTIVE:To analyze whether age differences is a significant independent predictor of in-hospital clinical outcomes in patients with acute ST-elevation myocardial infarction treated with domestic rapamycin drug-eluting stent implantation. METHODS:A retrospective analysis was done in 307 patients with first acute ST-elevation myocardial infarction treated with emergent rapamycin drug-eluting stent implantation for primary percutaneous coronary intervention. According to the age, there were three groups: non-elderly group (< 65 years old,n=175), low-elderly group (65-74 years old,n=83), and high-elderly group (≥ 75 years old,n=49). Clinical features, mortality, cardiac events during in-hospital stay were compared among three groups. RESULTS AND CONCLUSION: Compared with the non-elderly group, the proportion of female patients and the history of hypertension were higher in the low-elderly or high-elderly group (P < 0.05). The history of smoking was higher in the non-elderly group than the other groups (P < 0.05). The incidences of Kilip classification≥II, three-lesion or left main coronary artery disease were higher in the high-elderly group than the other groups (P < 0.05). Hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, and cholesterol levels were higher in the non-elderly group than the other groups (P < 0.05). Serum creatinine level, incidence of malignant arrhythmia and incidence of in-hospital cardiac death were increased with aging. Successful reperfusion was higher in the high-elderly group than in the low-elderly or non-elderly group. Rate of acute heart failure and combined cardiovascular events were higher in the high-elderly group than in the low-elderly or non-elderly group (P < 0.05). Multivariate logistic regression analysis show that age is an independent risk factor for in-hospital mortality in patients with acute ST-elevation myocardial infarction treated with rapamycin drug-eluting stent implantation.