| Background and Objective: Recent years, increasing morbidity of non-ST-segmentelevation acute coronary syndrome (NSTEACS) has become one of the mostimportant reasons of death and disability in developed countries and our nation.Because of poor clinical prognosis, patients with non-ST-segment elevationmyocardial infarction (NSTEMI) are the high-risk individuals in NSTEACS.Epidemiological studies showed that the morbidity of NSTEMI had been increasingyear by year, compared with STEMI. In addition, the elderly represent a growingproportion of the general population. The increasing prevalence of coronary arterydisease (CAD) is associated with aging. With the current developments ofevidence-based medicine and percutaneous coronary intervention, studies haveconfirmed that compared with2003, in-hospital mortality in elderly with NSTEMIdecreased by20%in2006. However, there was no difference on the1-year follow-up.Elderly patients with acute coronary syndrome were treated as special populationsin2007ACC/AHA unstable angina and NSTEMI treatment guidelines. Elderlypatients are more likely to have chronic diseases that cause poor outcomes. Therefore, focusing on eldly patients in this study has more clinical significance.The study aimedto investigate the incidences of cardiovascular adverse events in patients withNSTEMI during hospitalization and long-term follow-up (3years), and assess thelong-term prognosis and related factors in elderly NSTEMI Patients (≥65years).Methods: This was a retrospective and single-center clinical study. The medicaldocuments of those patients stored in the PCI follow-up database and medical recordsin the First Affiliated Hospital of Dalian Medical University were reviewed in thecurrent study. From December2006to December2012, a total of1304patientsdiagnosed of NSTEMI aged between29and97(range:68.70±11.86years) wereconsecutively enrolled in our study including860cases of eldly patients (≥65years)and444cases of young and middle-aged ones (<65years old). Unified follow-upquestionnaire was used to visit the NSTEMI patients after discharge,110patients diedin hospital and181cases were lost to follow-up. The primary endpoints were deathfrom any cause and cardiac death.and the secondary endpoints (composite endpoints)included death, recurrent infarction, recurrent angina and heart failure.Results:1. Compared with young and middle-aged patients, the elderly had morehypertension, diabetes mellitus, history of stroke, admission Killip≥3, serumcreatinine and BNP.2. Compared with young and middle-aged patients,the elderly were less likely to takeaspirin (95.46%vs.98.19%), clopidogrel (91.74%vs.96.62%), β-receptor blockers(76.27%vs.83.10%) and statins (91.62%vs.97.07%) and the elderly were more tochoose conservative treatment (68.83%vs.46.39%).3. There were total204cases of cardiac events (15.64%) during hospitalization,including174cases (85.29%) in elderly patients. The rates of primary endpoint andsecondary endpoint in elderly patients were higher than young and middle-aged ones,including death from any cause (11.04%vs.3.37%), recurrent angina (5.58%vs2.70%), heart failure (8.72%vs.2.74%) and recurrent myocardial infarction (2.44%vs.0.67%). 4. The long-term follow-up of total1,013cases were finished succesfully including660cases (75.15%) in elderly. The interval of follow-up was from1to81monthsand the median follow-up was30months. There was different median follow-up timebetween the two froups (27vs.33months,P=0.004). The rates of primary endpointand secondary endpoint in elderly patients were higher than young and middle-agedones, including death from any cause ((25.3%vs.3.4%), heart failure (9.7%vs.2.0%)and recurrent myocardial infarction (17.0%vs7.4%).5. Single factor analysis showed the rates of the primary endpoint event andsecondary one for the eldly were2.665times and2.176times that of young andmiddle-aged ones during hospitalization and7.724times and2.041times during the3yeas follow-up.6.Multivariate COX regression analysis showed that creatinine (RR=1.005，95%CI:1.004～1.007), admission Killip≥3(RR=7.517，95%CI:3.586～15.759); elderly (≥65years old)(RR=2.675，95%CI:1.297～5.517) were independent risk factors ofdeath for NSTEMI patients; creatinine (RR=1.004，95%CI:1.001～1.007), admissionKillip≥3(RR=4.200，95%CI:2.415～7.302) were independent risk factors ofcomposite endpoint during hospitalization. The elderly (≥65years old)(RR=3.924，95%CI:1.802～8.547), creatinine (RR=1.004，95%CI:1.002～1.005), admission Killip≥3(RR=1.869，95%CI:1.487～2.350), aspirin (RR=0.519，95%CI:0.296～0.910),revascularization therapy (RR=0.103，95%CI:0.014～0.746) were independent ofdeath for NSTEMI patients; the elderly (≥65years old)(RR=1.608，95%CI:1.239～2.086), creatinine (RR=1.002，95%CI:1.001～1.004), admission Killip≥3(RR=1.889，95%CI:1.366～2.613), aspirin (RR=0.519，95%CI:0.296～0.910) andrevascularization therapy (RR=0.719，95%CI:0.552～0.935)were independentfactors of composite endpoint in patients outside the hospital during the3yeasfollow-up..Conclusions:（1）The elderly patients with NSTEMI are more likely to havehypertension, diabetes, kidney dysfunction, heart failure and other risk factors andcomorbidities.(2) Elderly NSTEMI patients received less Evidence-based treatments for and reperfusion therapy than young and middle-aged ones,（3）The outcomesduring hospitalization and follow-up were worse than young and middle-aged ones.Therefore, particular attention should be paid to eldly patients with NSTEMI. |
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