主页 > 医学信息 >
【文摘发布】CRUSADE 研究初步结果：90岁以上急性
With Acute Coronary Syndromes . Results From the CRUSADE Initiative
author:Adam H. Skolnick, MD*, Karen P. Alexander, MD
abstract
Objectives: The goal of this work was to explore the treatment and outcomes of patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) age 90 years.
Background: The elderly are often excluded from clinical trials of NSTE-ACS and are underrepresented in clinical registries.
Methods: We used data from the CRUSADE registry to study 5,557 patients with NSTE-ACS age 90 years and compared their baseline characteristics, treatment patterns, and in-hospital outcomes with a cohort age 75 to 89 years (n = 46,270).
Results: Although both groups had much in common, compared with the younger elderly, the older elderly were less likely to be diabetic, smokers, or obese. Among patients without contraindications, the older elderly were less likely to receive glycoprotein IIb/IIIa inhibitors and statins during the first 24 h and were less likely to undergo cardiac catheterization within 48 h. The older elderly were more likely to die (12.0% vs. 7.8%) and experienced more frequent adverse events (26.8% vs. 21.3%) during the hospitalization—differences that persisted after adjustment for baseline patient and hospital characteristics. Increasing adherence to guideline-recommended therapies was associated with both increased bleeding and a graded reduction in risk-adjusted in-hospital mortality across both age groups.
Conclusions: In this large population of nonagenarians and centenarians with NSTE-ACS, increasing adherence to guideline-recommended therapies was associated with decreased mortality. These findings reinforce the importance of optimizing care patterns for even the oldest patients with NSTE-ACS, while examining novel approaches to reduce the risk of bleeding in this rapidly expanding patient population.
J Am Coll Cardiol, 2007; 49:1790-1797
http://content.onlinejacc.org/cgi/content/abstract/49/17/1790 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Title:Characteristics, Management, and Outcomes of 5,557 Patients Age 90 Years
With Acute Coronary Syndromes . Results From the CRUSADE Initiative
标题：CRUSADE 研究初步结果：90岁以上急性冠脉综合征患者的临床特征、干预及预后
abstract
Objectives: The goal of this work was to explore the treatment and outcomes of patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) age 90 years.
目的：本研究旨在探讨90岁以上非ST段抬高急性冠脉综合征（NSTE-ACS）患者的治疗措施及预后。
Background: The elderly are often excluded from clinical trials of NSTE-ACS and are underrepresented in clinical registries.
背景：老年患者通常既往NSTE-ACS临床研究通常将老年人排除在外，老年人临床注册研究中不具代表性。
Methods: We used data from the CRUSADE registry to study 5,557 patients with NSTE-ACS age 90 years and compared their baseline characteristics, treatment patterns, and in-hospital outcomes with a cohort age 75 to 89 years (n = 46,270).
方法：本研究利用CRUSADE注册研究数据，纳入5557名患者为研究对象，比较90岁以上NSET-ACS患者（年老组）与年龄介于75-89岁间的另一组患者（年轻组）的基线特征，治疗模式及院内结果。
Results: Although both groups had much in common, compared with the younger elderly, the older elderly were less likely to be diabetic, smokers, or obese. Among patients without contraindications, the older elderly were less likely to receive glycoprotein IIb/IIIa inhibitors and statins during the first 24 h and were less likely to undergo cardiac catheterization within 48 h. The older elderly were more likely to die (12.0% vs. 7.8%) and experienced more frequent adverse events (26.8% vs. 21.3%) during the hospitalization—differences that persisted after adjustment for baseline patient and hospital characteristics. Increasing adherence to guideline-recommended therapies was associated with both increased bleeding and a graded reduction in risk-adjusted in-hospital mortality across both age groups.
结果：两组大部分情况均类似，与年轻组相比，年老组患者中糖尿病、吸烟、肥胖人数较少。在没有禁忌症的患者中，在入院24小时内，年老组中较少接受糖蛋白IIB/IIIa受体拮抗剂、他汀治疗，在入院48小时较少接受心导管术。在消除基线及临床特征差异后，与年轻组相比，老年组住院期间死亡率、不良反应发生率较高[分别为12.0% vs. 7.8%；26.8% vs. 21.3%]。指南推荐的治疗方案的采用增加使得院内死亡率下降，但出血发生率升高。
Conclusions: In this large population of nonagenarians and centenarians with NSTE-ACS, increasing adherence to guideline-recommended therapies was associated with decreased mortality. These findings reinforce the importance of optimizing care patterns for even the oldest patients with NSTE-ACS, while examining novel approaches to reduce the risk of bleeding in this rapidly expanding patient population.
阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-02-20 05:11
医学,生命科学网