| Abstract | Cilj: Stariji bolesnici s AKS-om se zbog svoje visoke životne dobi i komorbiditeta rjeđe liječe invazivnom strategijom koja uključuje revaskularizaciju što može negativno utjecati na njihovo preživljenje. Cilj ovog istraživanja bio je analizirati strategije liječenja kod bolesnika ≥ 80 godina s AKS-om te ishode obzirom na terapijski pristup.
Materijali i metode: Ovo retrospektivno istraživanje obuhvatilo je 488 bolesnika ≥ 80 godina koji su se od studenog 2018. do listopada 2023. prezentirali s AKS-om u Kliničkom bolničkom centru Zagreb. Statistička analiza je provedena na temelju podataka koji su prikupljeni iz medicinske dokumentacije.
Rezultati: Od 488 bolesnika, s medijanom dobi od 84 [82–87] godine i 50,2% žena, 214 (43,9%) je imalo STEMI, a 274 (56,1%) NSTE-AKS. Ukupno su tijekom 6 mjeseci praćenja umrla 123 (25,2%) bolesnika, a značajno više je umrlo bolesnika sa STEMI-jem nego NSTE-AKS-om (31,3% vs. 20,4%, p = 0,006) neovisno o strategiji liječenja. Invazivnom strategijom je liječeno 288 (59,0%) bolesnika s AKS-om, značajno češće bolesnici sa STEMI-jem (71,0% vs. 49,6%, p < 0,001). Ženski spol (OR = 0,52; 95% CI: 0,30–0,90; p = 0,020), aortna stenoza (OR = 0,43; 95% CI: 0,20–0,90; p = 0,025) i anemija (OR = 0,41; 95% CI: 0,17–0,99; p = 0,048) bili su čimbenici koji su negativno utjecali na izbor invazivnog liječenja u bolesnika s NSTE-AKS-om. Kod bolesnika liječenih invazivnim pristupom, u obje skupine obzirom na vrstu AKS-a, zabilježena je značajno manja intrahospitalna smrtnost (STEMI: 9,2% vs. 27,4%, p < 0,001; NSTE-AKS: 0,7% vs. 8,0%, p = 0,003), smrtnost tijekom 30 dana praćenja (STEMI: 18,4% vs. 37,1%, p = 0,004; NSTE-AKS: 2,2% vs. 15,2%, p < 0,001) i smrtnost tijekom 6 mjeseci praćenja (STEMI: 25,7% vs. 45,2%, p = 0,005; NSTE-AKS: 8,1% vs. 32,6%, p < 0,001). Učestalost ponovnog infarkta miokarda i cerebrovaskularnog inzulta nije se razlikovala između bolesnika liječenih invazivnom i konzervativnom strategijom ni u skupini sa STEMI-jem ni u skupini s NSTE-AKS-om. Multivarijabilnom regresijskom analizom je utvrđeno kako su invazivna strategija liječenja (HR = 0,33; 95% CI: 0,16–0,69; p = 0,003) i terapija ACE inhibitorima ili ARB-ovima (HR = 0,34; 95% CI: 0,17–0,67; p = 0,002) pozitivni prediktori šestomjesečnog preživljenja u bolesnika s NSTE-AKS-om, dok invazivni pristup kod bolesnika sa STEMI-jem nije pokazao statistički značajnu povezanost (HR = 0,59; 95% CI: 0,27–1,30; p = 0,192).
Zaključak: Ovo istraživanje je pokazalo da se bolesnici ≥ 80 godina s NSTE-AKS-om rjeđe liječe invazivnim pristupom nego bolesnici sa STEMI-jem. Invazivna strategija liječenja je povezana s boljim preživljenjem u ovoj populaciji neovisno o vrsti AKS-a, dok se učestalost ponovnog infarkta miokarda i cerebrovaskularnog inzulta značajno ne razlikuje između skupina liječenih različitim terapijskim pristupom. |
| Abstract (english) | Objective: Elderly patients with ACS are less frequently treated with an invasive strategy, including revascularization, due to their advanced age and comorbidities, which can negatively impact their survival. This study aimed to analyze treatment strategies in patients aged ≥ 80 years with ACS and outcomes concerning the therapeutic approach.
Materials and methods: This retrospective study included 488 patients aged ≥ 80 years who presented with ACS at the University Hospital Centre Zagreb from November 2018 to October 2023. The statistical analysis was conducted based on data collected from medical records.
Results: Among the 488 patients, with a median age of 84 [82–87] years and 50.2% women, 214 (43.9%) had STEMI and 274 (56.1%) had NSTE-ACS. During the 6-month follow-up period, a total of 123 (25.2%) patients died, with significantly more deaths occurring in patients with STEMI compared to those with NSTE-ACS (31.3% vs. 20.4%, p = 0.006), regardless of the treatment strategy. An invasive strategy was used to treat 288 (59.0%) patients with ACS, significantly more frequently in patients with STEMI (71.0% vs. 49.6%, p < 0.001). Female sex (OR = 0.52; 95% CI: 0.30–0.90; p = 0.020), aortic stenosis (OR = 0.43; 95% CI: 0.20–0.90; p = 0.025), and anemia (OR = 0.41; 95% CI: 0.17–0.99; p = 0.048) were factors that negatively influenced the choice of invasive treatment in patients with NSTE-ACS. Among patients treated with an invasive approach, significantly fewer in-hospital deaths (STEMI: 9.2% vs. 27.4%, p < 0.001; NSTE-ACS: 0.7% vs. 8.0%, p = 0.003), 30-day follow-up deaths (STEMI: 18.4% vs. 37.1%, p = 0.004; NSTE-ACS: 2.2% vs. 15.2%, p < 0.001), and 6-month follow-up deaths (STEMI: 25.7% vs. 45.2%, p = 0.005; NSTE-ACS: 8.1% vs. 32.6%, p < 0.001) were recorded in both groups, depending on the type of ACS. The incidence of recurrent myocardial infarction and cerebrovascular stroke did not differ between patients treated with invasive and conservative strategies in either the STEMI or NSTE-ACS groups. Multivariable regression analysis revealed that an invasive treatment strategy (HR = 0.33; 95% CI: 0.16–0.69; p = 0.003) and therapy with ACE inhibitors or ARBs (HR = 0.34; 95% CI: 0.17–0.67; p = 0.002) were positive predictors of six-month survival in patients with NSTE-ACS, whereas the invasive approach in patients with STEMI did not show a significant association (HR = 0.59; 95% CI: 0.27–1.30; p = 0.192).
Conclusion: This study showed that patients aged ≥ 80 years with NSTE-ACS are less frequently treated with an invasive approach than those with STEMI. The invasive treatment strategy is associated with better survival in this population, regardless of the type of ACS. At the same time, the incidence of recurrent myocardial infarction and cerebrovascular stroke does not significantly differ between groups treated with different therapeutic approaches. |
