| Objective:To investigate the clinical characteristics of elderly patients with acute coronary syndromes(ACS) and the effectiveness of percutaneous coronary intervention(PCI) on the prognosis of elderly patients with ACS.Methods:There were 2,400 inpatients with ACS in the Cardiology Division of our hospital from November 2011 to September 2013, of which 1,640 inpatients were consecutively enrolled in this study in accordance with the inclusion criteria. We diagnosed with ACS after 507 of the 1,640 coronary angiography, who were then divided into two groups by age,young and middle-aged group with 298 cases(age < 60 years, 58.78%) and elderly group with 209 cases(age ≥ 60, 41.22%). Meanwhile, 374 ACS patients over 75 years of age, were divided into two groups: PCI group(55,14.71%) and conservative drug treatment group(319,85.29%).This study collected all the clinical data of the research objects and the characteristics of coronary angiography by the doctors in cardiology division to analyse the clinical characteristics of elderly patients with ACS.Analysised the prognosis of elderly ACS patients by Cox proportional hazards model.Results: I) Clinical characteristics of elderly patients with ACS:1. Median age of young and middle-aged group was 53 years while that of the elderly group was 68 years. The percentage of female in elderly group was higher than that of young and middle-aged group [31.58%(66/209) than 16.44%,(49/298), P<0.05). Compared with the young and middle-aged group, elderly group contained less dyslipidemia patients [36.36%(76/209), 45.30%(135/298), P<0.05)], and more diabetes mellitus patients [31.10%(65/209), 19.80%(59/298), P<0.05)]. There was no statistically significant difference between the two groups on the prevalence of hypertension patients. Elderly group contained 63 patients(30.14%) with smoking history, while there were 175 among young and middle-aged group(58.72%),P<0.001. 46 patients had a long history of heavy drinking within the elderly group(22.01%), while there were 90 cases in the young and middle-aged group(30.20%),P<0.05. Elderly patients were proved to merge more risk factors.2. Most of coronary artery lesions in young and middle-aged group were one-vessel diseases[43.96%(131/298) to 32.54%(68/209), P<0.05],but the multi-vessel diseases[40.67%(85/209), 30.20%(90/298), P<0.05)]was more frequent in elderly group.The Gensini Score of elderly group was higher than that of young and middle-aged group [10(4,20.25) to 7.5(3,15.5), P<0.05).Evaluated the severity of coronary artery lesion by Gensini Score, the number of patients with severe stenosis of coronary artery in elderly group was higher than that in young and middle-aged group [27.27%(57/209) to 14.43%(43/298), P<0.05] while mild stenosis of coronary artery occurred more in the young and middle-aged group [85.57%(255/298) to 72.73%(152/209), P<0.05].II) Risk factors affecting the prognosis of elderly ACS patients1. Comparison on baseline clinical data among elderly ACS patients : Median age of the elderly ACS patients(75 or higher) included in this study was 77 years old, with 200 males(53.48%) and 174 females(46.52%), 78 STEMI patients(20.86%) and, 296 NSTEMI/UA cases(79.14%). There was no statistically significant difference between the PCI group and the conservative treatment group in terms of age, sex, hypertension, diabetes, dyslipidemia, and smoking history(P>0.05) When it comes to compare the clinic characteristics of the two groups, such as admission heart rate, cardiac function, proportion of anterior wall myocardial infarction, cardiac shock, acute pulmonary edema, etc,the difference was not significant(all P>0.05). Same with the difference, the history of myocardial infarction, heart failure, ischemic/hemorrhagic stroke, the proportion of the chronic renal failure, there was no statistically significant diffidence between the two groups(P>0.05). The number of STEMI patients in PCI group was higher than conservative treatment group [40.00%(22/55) than 17.55(56/319), P<0.001).2. Comparison on the secondary prevention : With the aim of strengthening the effect of antiplatelet and preventing from stent restenosis, prescription rates of clopidogrel in PCI group was obviously higher than that of conservative treatment group. 53 of the 55 cases in PCI group received clopidogrel treatment(prescription rate:96.36%) whereas only 67 of the 319 cases in the conservative treatment group were treated with clopidogrel(prescriptionrate: 21.00%). The difference between the two groups was statistically significant, P<0.001. The ratios of secondary prevention drugs, such as aspirin, ACEI, ARB, beta blockers and statins, were not statistically significant between the two groups, P>0.05.3. Results of follow-up: The median follow-up time was 630 days. Of the 319 cases in the conservative treatment group,92 died(28.9%), 132 incurred with major adverse cardiovascular events(41.5%); In PCI group(55 cases), 3 died(5.5%), 15 incurred with major adverse cardiovascular events(27.3%). Comparing the two groups, the difference was statistically significant(P<0.05).4. This study conducted single factor analysis on gender, age, hypertension, diabetes, stroke, anemia, heart failure, renal failure, cardiac shock, and acute pulmonary edema, with test level being 0.05, have proved statistical significance(P<0.05). By drawing the survival curves and conducting Log- rank test for both PCI and conservative treatment group, the difference between the two groups was proved as being statistically significant,(P<0.05).In the Cox proportional hazard model, cardiogenic shock(HR 8.00), acute pulmonary edema(HR 4.61), heart failure history(HR 7.51) and female(HR 3.57) were found to be independent risk factors for failed prognosis in elderly ACS patients over 75 years old, all P<0.05. However, PCI was the importantly protective factor for ACS in the elderly(HR 0.21).Conclusion:The prevalence of ACS female patients increases., especially coming with menopause. Compared with young and middle-aged group of patients, elderly patients combine a variety of complications and complex coronary artery lesions. The ratio of ACS patients who are over 75 years old and who have received PCI treatment is low. However, it dose not mean old age is the absolute contraindication of interventional treatment.PCI can still reduce all-cause mortality and MACE in the elderly patients with ACS, and significantly improve the prognosis of patients, meaning elderly patients can still benefit from the intervention treatment. Cardiac shock, acute pulmonary edema, heart failure and women, are the independent risk factors influencing the prognosis of elderly patients with ACS. The doctor should combine the clinical features of elderly ACS patients with ACS into the selection of appropriate intervention measures. |
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