Comparative Study for the Prognosis of Intra-aortic Balloon Pump Counter-pulsation Supported Primary PCI Between Very Elderly and Elderly STEMI Patients
10.3969/j.issn.1000-3614.2018.03.003
- VernacularTitle:年龄≥80岁和年龄＜80岁的急性ST段抬高型心肌梗死患者主动脉内球囊反搏支持下直接经皮冠状动脉介入治疗预后的对比研究
- Author:
Pei ZHANG
1
;
Jun DAI
;
Chao-Yang ZHANG
;
Yuan WU
;
Bo XU
;
Shi-Jie YOU
;
Yong-Jian WU
;
Hai-Bo LIU
;
Xue-Wen QIN
;
Hong-Bing YAN
;
Min YAO
;
Shu-Bin QIAO
;
Yue-Jin YANG
;
Ji-Lin CHEN
;
Run-Lin GAO
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 冠心病诊治中心
- Keywords:
Elderly;
Myocardial infarction;
Percutaneous coronary intervention;
Intra-aortic balloon pump counter-pulsation
- From:
Chinese Circulation Journal
2018;33(3):217-221
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To compare the prognosis of intra-aortic balloon pump (IABP) supported primary percutaneous coronary intervention (PPCI) between very elderly (age ≥ 80 years) and elderly (age < 80 years) patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 288 STEMI patients received IABP supported PPCI in our hospital from 2004-01 to 2015-12 were retrospectively studied. Clinical condition, coronary angiography and follow-up data were analyzed; the patients with pre-operative cardiac shock, mechanical complication and non ST-segment elevation acute coronary syndrome were excluded. Eligible patients were divided into 2 groups: Very elderly group, n=51 and Elderly group, n=237. Major adverse cardiac and cerebral events (MACCE) as death, cardiac shock, new or worsen heart failure, re-MI and stroke were studied at 1 month and 1, 2 years after PPCI. Independent predictors for MACCE occurrence were investigated by Cox proportional hazard model analysis.Results: Compared with Elderly group, Very elderly group had increased incidence of MACCE at 1 month after PPCI (41.2% vs 24.5%), P=0.029 and obviously elevated incidence of stroke (9.8% vs 0.8%), P<0.001. Mortalities were similar between 2 groups at 1 month and 1 year after PPCI (17.6% vs 15.2%) and (25.5% vs 16.9%), both P>0.05; mortality was higher in Very elderly group at 2 years after PPCI (35.3% vs 20.7%), Log-rank P=0.037. Cox proportional hazard model analysis indicated that post-operative TIMI flow < 3 was the strong independent predictor for MACCE occurrence (HR=3.41, 95% CI 2.09-5.56, P<0.001), which was also the strongest predictor for death at different time points as at 1 month after PPCI (HR=9.51, 95% CI 5.23-17.29), at 1 year after PPCI (HR=7.24, 95% CI 4.13-12.69) and at 2 years after PPCI (HR=5.85, 95% CI 3.45-9.94), all P<0.001. Patients ≥ 80 years had no obvious predictors for end point event occurrence. Conclusion: Very elderly STEMI patients had the higher mortality at 2 years after IABP supported PPCI and increased incidence of MACCE at 1 month after PPCI. Patients≥80 years had no obvious predictors for end point event occurrence.
