| Background and purpose: Multiple randomized controlled trials(RCTs)have demonstrated that patients with non-ST-elevation myocardial infarction(NSTEMI)treated with percutaneous coronary intervention(PCI)have improved outcomes compared to conservative treatment with medication alone.However,most of these RCTs subjects were around 65 years old,and there is still insufficient data on whether interventional therapy is beneficial for NSTEMI patients over 80 years old.This study was a single-center,retrospective endpoint evaluation clinical study,aiming to compare the effects of interventional therapy and conservative drug treatment on the long-term prognosis of elderly patients with NSTEMI,to explore the factors affecting the survival time of elderly patients with NSTEMI,and to develop a more effective treatment plan for elderly patients with NSTEMI.Methods: Patients aged ≥80 years who were first diagnosed with NSTEMI in Asian Heart Hospital from 2014 to 2015 were selected and divided into interventional treatment group and conservative treatment group according to different treatment plan during hospitalization.The follow-up was performed by outpatient service and telephone follow-up.The follow-up deadline was September 30,2020,and the end point was all-cause death.The propensity score matching method was used to match the patients in the two groups according to the ratio of 1:1,the baseline data and end point events of the two groups of patients before and after matching were statistically analyzed.We used Graph Pad PRism software to plot survival curves and Kaplan-Meier analysis to compare 5-year all-cause mortality between the two groups,and to evaluate the impact of interventional therapy and conservative drug treatment on the long-term prognosis of elderly patients with NSTEMI.Univariate and multivariate Cox proportional risk regression models were used to analyze the related factors affecting the survival time of elderly patients with NSTEMI.Results: A total of 128 elderly patients with NSTEMI were included in the study,including 53 patients in the interventional therapy group and 75 patients in the conservative medical treatment group.There were no significant differences in general data such as age at conservative treatment with interventional drugs,history of hypertension,history of diabetes,KILLIP grade ≥ 3,peak troponin I,peak B-type natriuretic peptide,glycosylated hemoglobin,LDL-C,glomerular filtration rate,heart rate immediately after admission,GRACE score,and end-diastolic transverse diameter(P>0.05).The proportion of male and ejection fraction in the intervention group were higher than those in the conservative group,while the number of abnormal ventricular wall motion,CRUSADE score and D-dimer were lower than those in the conservative group,and the differences were statistically significant(P<0.05).Through propensity scoring method,53 pairs were successfully matched(53 cases in the interventional treatment group and 53 cases in the conservative drug treatment group),there was no statistical difference in baseline data between the two groups after matching except for the CRUSADE score.In the data before the match,the 5-year survival rate was 73.6%with a mean survival time of 61 months in the interventional group and 41.3% with a mean survival time of 46 months in the medical conservative group;In the data after the match,the 5-year survival rate was 73.6% with a mean survival time of 61.8 months in the interventional group and 49.1% with a mean survival time of 49.2 months in the conservative medical group(P=0.014).In the CRUSADE subgroup survival analysis,interventional therapy still improved the 5-year survival and mean survival time of elderly NSTEMI patients(P=0.025).Using multivariate Cox regression model analysis,we found that in the data before the propensity score matching,LDL-C(P=0.047,HR=1.372,95%CI:1.004～1.875),CRUSADE score(P=0.050,HR=1.019,95%CI:1.000～1.038),abnormal ventricular wall motion(P=0.030,HR=0.467,95%CI :0.235～0.928),PCI treatment(P= 0.044,HR=0.503,95%CI :0.258～0.981)were independent factors affecting the survival of prognosis;In the data after the propensity score matching;diabetes history(P=0.036,HR=0.476,95%CI:0.239～0.951)and PCI treatment(P=0.044,HR=0.485,95%CI :0.240～0.980)were independent factors affecting the survival of prognosis.The area under the ROC curve of the CRUSADE score for the occurrence of 5-year all-cause deaths was 0.619(P=0.040,95%CI :0.508～0.730),the Yuden index was 0.214,the sensitivity was 0.366,the specificity was 0.877,and the best cutoff value was 41.5.There was a correlation between GRACE risk score and CRUSADE risk score,and the risk stratification of GRACE score alone had no statistical significance in the 5-year survival assessment of elderly patients with NSTEMI(P=0.249).While,risk stratification by the CRUSADE score was statistically significant for the 5-year survival of elderly patients with NSTEMI(P=0.039).In addition,risk stratification after CRACE score combined with CRUSADE score was more statistically significant for the prognosis assessment of elderly patients with NSTEMI(P=0.000).Conclusions:1.For older patients with NSTEMI,interventional therapy can still improve 5-year survival and mean survival.2.Both in the data before the propensity score matching and in the data after the matching,multivariate Cox regression analysis showed that interventional therapy was an independent protective factor affecting the survival and prognosis of elderly patients with NSTEMI.3.The CRUSADE score has a significance to predict the occurrence of 5-year all-cause death events in elderly patients with NSTEMI,and when the CRUSADE score exceeds 41.5,the hope of predicting the survival of patients after 5 years is low.4.Risk stratification after the combination of CRACE score and CRUSADE score had statistical significance for the prognosis assessment of elderly patients with NSTEMI. |
PDF Full Text Request