Primer perkütan koroner girişim uygulanan st-segment elevasyonlu miyokard infarktüsü tanılı 80 yaş üstü hastaların bir yıllık takip sonuçları
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Dünyada yaşlı nüfusunun artmasıyla orantılı olarak klinik pratikte karşılaşılan ST-segment elevasyonlu miyokard infarktüs (STEMİ) tanılı yaşlı ve çok yaşlı hastaların sıklığı da artış göstermektedir. STEMİ hastaları için tüm yaş gruplarında öncelikli tercih edilen reperfüzyon stratejisi primer perkütan koroner girişim olmasına rağmen klinik çalışmalarda 80 yaş ve üstü kırılgan hastaların yeterli oranda temsil edilmediği görülmektedir. Bu çalışmada STEMİ tanısıyla hastaneye kabul edilen ve primer perkütan koroner girişim uygulanan ?80 yaş hastaların hastane içi ve bir yıllık takip dönemindeki klinik izlem sonuçlarını, kardiyak istenmeyen olay gelişimi ile ilişkili faktörleri araştırmayı ve bu sonuçların 80 yaş altı hastaların verileriyle karşılaştırmayı amaçladık. Toplamda 449 STEMİ hastası çalışmaya dahil edildi. Hastalar 80 yaş ve üzeri ve 80 yaş altı olarak iki alt gruba ayrıldı. 80 yaşın altındakilerin sayısı 350, 80 yaş ve üzerinde olanların sayısı ise 99'du. Bu iki grubun, klinik özellikleri, kardiyovasküler risk faktörleri, hastane içi komplikasyonlar ve olayları, perkütan koroner girişim özellikleri ve 1 yıllık sonuçları karşılaştırıldı. Ayrıca 80 yaş ve üzeri hastalarda, hastane içi mortalite, 1 yıllık mortalite ve 1 yıl içinde gelişen tekrarlayan kardiyak olayları predikte eden faktörler araştırıldı. Yaşlı hastaların genç hastalara göre, kardiyovasküler risk faktörleri ve komorbit hastalıklarının daha fazla olduğu bulundu (hipertansiyon p<0,001, atriyal fibrilasyon p:0,001, kronik böbrek yetmezliği p:0,031). Yaşlı hastaların ağrı başlangıç saati ve kapı-balon süresinin uzun olması nedeniyle total iskemik süresinin genç hastalara göre daha yüksek olduğu saptandı (ağrı başlangıcı p:0,040, kapı-balon zamanı p:0,066). Yaşlı hastaların hastane içi mortalitesi %31,3, 1 yıllık mortalitesi ise %20,6 olarak bulundu ve genç hastalara göre daha yüksek olduğu görüldü (hastane içi mortalite p<0,001, 1 yıllık mortalite p<0,001). 80 yaş ve üzeri hastalarda hastane içi mortaliteyi predikte eden faktörler, Killip?2 akut kalp yetmezliği ile başvuru [OR (%95 GA): 27,23 ( 3,42-216,66), p:0,002 ], VT-VF gelişmesi [OR (%95 GA): 20,35 ( 3,12-132,82), p:0,002], akut böbrek yetmezliği gelişmesi [OR (%95 GA): 8,12 ( 1,53- 42,94 ), p:0,014 ] ve koroner no-reflow/yavaş akım gelişmesi [OR (%95 GA): 14,56 ( 1,61-131,09 ), p:0,017] olarak bulundu. 80 yaş ve üzeri hastalarda 1 yıl içindeki mortaliteyi predikte eden faktörler, kapı balon zamanının uzun olması [ OR (%95 GA): 1,04 ( 1,01-1,07 ) p:0,003 ] ve ACEİ/ARB grubu ilaçları kullanmamak [ OR (%95 GA): 0,23 ( 0,52-1,09 ), p:0,065 ] olarak bulundu. 80 yaş ve üzeri hastalarda 1 yıl içinde tekrarlayan olay gelişimini predikte eden faktörler, kapı-balon zamanının uzun olması [ OR (%95 GA): 1,04 ( 1,01-1,07 ), p:0,007 ], yüksek E/E' [OR (%95 GA): 1,80 ( 1,07-3,02 ), p:0,026 ] ve kısa DAPT süresi [ OR (%95 GA): 0,85 ( 0,74-0,98 ), p:0,033 ] olarak bulundu. Sonuç olarak, 80 yaş ve üzeri STEMİ tanılı kırılgan hasta popülasyonunda hem hastane içi mortalite, hem de 1 yıllık takip döneminde mortalite ve istenmeyen kardiyak olay sıklığı, 80 yaş altındaki hastalar ile karşılaşırıldığında anlamlı derecede yüksek saptanmıştır. Anahtar kelimler: 80 yaş, STEMİ, perkütan koroner girişim, mortalite, 1 yıllık takip, prediktör faktörler.
In proportion to the increase in the elderly population in the world, the frequency of elderly and very elderly patients with a diagnosis of ST-segment elevation myocardial infarction (STEMI), which is encountered in clinical practice, is also increasing. Although primary percutaneous coronary intervention is the preferred reperfusion strategy for STEMI patients in all age groups, it is seen that frail patients aged 80 and over are not adequately represented in clinical studies. In this study, we aimed to investigate the clinical follow-up results of patients aged ?80 years, who were admitted to the hospital with the diagnosis of STEMI and underwent primary percutaneous coronary intervention, during the in-hospital and one-year follow-up period, the factors associated with the development of cardiac adverse events, and to compare these results with the data of patients under 80 years of age. A total of 449 STEMI patients were included in the study. The patients were divided into two subgroups as 80 years and older and under 80 years old. The number of those under the age of 80 was 350, and the number of those aged 80 and over was 99. The clinical features, cardiovascular risk factors, in-hospital complications and events, percutaneous coronary intervention characteristics and 1-year results of these two groups were compared. In addition, factors predicting in-hospital mortality, 1-year mortality, and recurrent cardiac events within 1 year were investigated in patients aged 80 years and older. Elderly patients were found to have more cardiovascular risk factors and comorbid diseases than younger patients (hypertension p<0.001, atrial fibrillation p:0.001, chronic renal failure p:0.031). It was determined that the total ischemic time was higher in the elderly patients than in the younger patients due to the longer time of pain onset and the door-balloon time (pain onset p:0.040, door-balloon time p:0.066). In-hospital mortality of elderly patients was 31,3%, and 1-year mortality was 20,6%, and it was found to be higher than younger patients (in-hospital mortality p<0.001, 1-year mortality p<0.001). Factors predicting in-hospital mortality in patients aged 80 and over, admission with Killip?2 acute heart failure [OR (95% CI): 27.23 (3.42-216.66), p:0.002 ], development of VT-VF [OR (95% CI): 20.35 (3.12-132.82), p:0.002], development of acute renal failure [OR (95% CI): 8.12 ( 1.53-42.94) ) , p:0.014 ] and coronary no-reflow/slow flow development [OR (95% CI): 14.56 (1.61-131.09 ), p:0.017]. Factors predicting mortality within 1 year in patients aged 80 and over, long gate-balloon time [OR (95% CI): 1.04 (1.01-1.07) p:0.003) and not using ACEI/ARB group drugs [ OR (95% CI): 0.23 (0.52-1.09), p:0.065 ]. Factors predicting the development of recurrent events within 1 year in patients aged 80 years and older, long gate-balloon time [OR (95% CI): 1.04 (1.01-1.07 ), p:0.007 ], high E/ E' [OR (95% CI): 1.80 ( 1.07-3.02 ), p:0.026 ] and short DAPT duration [ OR (95% CI): 0.85 (0.74-0.98) ), p:0.033 ]. In conclusion, in the fragil patient population aged 80 years and older with a diagnosis of STEMI, both in-hospital mortality and mortality in the 1-year follow-up period and the frequency of adverse cardiac events were found to be significantly higher when compared to patients under 80 years of age. Key words: 80 years, STEMI, percutaneous coronary intervention, mortality, 1-year follow-up, predictive factors.
In proportion to the increase in the elderly population in the world, the frequency of elderly and very elderly patients with a diagnosis of ST-segment elevation myocardial infarction (STEMI), which is encountered in clinical practice, is also increasing. Although primary percutaneous coronary intervention is the preferred reperfusion strategy for STEMI patients in all age groups, it is seen that frail patients aged 80 and over are not adequately represented in clinical studies. In this study, we aimed to investigate the clinical follow-up results of patients aged ?80 years, who were admitted to the hospital with the diagnosis of STEMI and underwent primary percutaneous coronary intervention, during the in-hospital and one-year follow-up period, the factors associated with the development of cardiac adverse events, and to compare these results with the data of patients under 80 years of age. A total of 449 STEMI patients were included in the study. The patients were divided into two subgroups as 80 years and older and under 80 years old. The number of those under the age of 80 was 350, and the number of those aged 80 and over was 99. The clinical features, cardiovascular risk factors, in-hospital complications and events, percutaneous coronary intervention characteristics and 1-year results of these two groups were compared. In addition, factors predicting in-hospital mortality, 1-year mortality, and recurrent cardiac events within 1 year were investigated in patients aged 80 years and older. Elderly patients were found to have more cardiovascular risk factors and comorbid diseases than younger patients (hypertension p<0.001, atrial fibrillation p:0.001, chronic renal failure p:0.031). It was determined that the total ischemic time was higher in the elderly patients than in the younger patients due to the longer time of pain onset and the door-balloon time (pain onset p:0.040, door-balloon time p:0.066). In-hospital mortality of elderly patients was 31,3%, and 1-year mortality was 20,6%, and it was found to be higher than younger patients (in-hospital mortality p<0.001, 1-year mortality p<0.001). Factors predicting in-hospital mortality in patients aged 80 and over, admission with Killip?2 acute heart failure [OR (95% CI): 27.23 (3.42-216.66), p:0.002 ], development of VT-VF [OR (95% CI): 20.35 (3.12-132.82), p:0.002], development of acute renal failure [OR (95% CI): 8.12 ( 1.53-42.94) ) , p:0.014 ] and coronary no-reflow/slow flow development [OR (95% CI): 14.56 (1.61-131.09 ), p:0.017]. Factors predicting mortality within 1 year in patients aged 80 and over, long gate-balloon time [OR (95% CI): 1.04 (1.01-1.07) p:0.003) and not using ACEI/ARB group drugs [ OR (95% CI): 0.23 (0.52-1.09), p:0.065 ]. Factors predicting the development of recurrent events within 1 year in patients aged 80 years and older, long gate-balloon time [OR (95% CI): 1.04 (1.01-1.07 ), p:0.007 ], high E/ E' [OR (95% CI): 1.80 ( 1.07-3.02 ), p:0.026 ] and short DAPT duration [ OR (95% CI): 0.85 (0.74-0.98) ), p:0.033 ]. In conclusion, in the fragil patient population aged 80 years and older with a diagnosis of STEMI, both in-hospital mortality and mortality in the 1-year follow-up period and the frequency of adverse cardiac events were found to be significantly higher when compared to patients under 80 years of age. Key words: 80 years, STEMI, percutaneous coronary intervention, mortality, 1-year follow-up, predictive factors.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Kardiyoloji, Cardiology
