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ȣ - 520092 164 |
| Korean Octogenarian Patients with non-ST Elevation Myocardial Infarction Have More Favorable Outcomes with Percutaneous Coronary Intervention |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 조재영, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
Background: Acute myocardial infarction (AMI) in patients older than 80 years may have different features compared with young patients. There is controversy over which strategy we should take in octogenarian patients with non-ST segment elevation myocardial infarction (NSTEMI). Subjects and Methods : We have studied 624 consecutive patients with NSTEMI, who were registered in Korea Acute Myocardial Infarction Registry (KAMIR) between Oct 2005 to Jun 2007 (83.5±3.6 years, 284 males). The patients were divided into two groups, patients who underwent percutaneous coronary intervention (Group I: 82.6±2.9 years, 162/332 males) and who did not (Group II: 84.3±3.9 years, 118/282 males). The clinical, laboratory findings and major adverse cardiac events (MACE) were compared between the two groups. Results: There was no significant gender difference (48.8% vs. 41.8%, p=0.085). Patients with low Killip class tended to undergo PCI (63.4% vs. 38.7%, p<0.001) and with high body mass index (22.6±3.3 vs. 21.7±3.9 kg/m2, p=0.002). In echocardiogram, left ventricular ejection fraction (LVEF) showed significant difference (50.4±13.4 vs. 45.8±13.6 %, <0.001). In laboratory findings, initial glucose level (167.1±84.2 vs. 186.1±99.5 mg/dL, p=0.014) and total cholesterol level (176.9±44.2 vs. 166.6±50.7 mg/dL, p=0.011) were different. There was no difference in hsCRP level (26.1±86.5 vs. 30.3±112.6 mg/dL, p=0.651), but NT proBNP showed significant difference (5502.7±7647.5 vs. 8814.8±10966.2, p=0.001). In-hospital mortality was lower in Group I than in group II (5.3% vs. 13.7%, p<0.001). The composite of one-year MACE showed significant difference between two groups (12.4% vs. 37.7%, p<0.001). Adjusting sex, obesity, initial Killip class, LVEF and NT-proBNP level, Cox proportional hazard regression showed that patients in group II had 6.5 times more risk of cardiac death [relative risk (RR) 6.527, 95% confidence interval (CI) 2.131-19.990, p=0.001] and 2.9 times MACE than in group I [RR 2.927, 95% CI 1.3305-6.563, p=0.009]. Conclusion : In Korean octogenarian patients with NSTEMI, patients who underwent PCI have shown better 1-year outcome than patients who received conservative treatment.
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