文档介绍：会计学
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复杂的亚组患者中的血运重建术葛均波英文
Revascularization in Complex Patient Subsets
The very elderly (C. Grines)
Complex CAD and diabetes (V. Fuster)
Chronic kidney disease (N. Lepor)
Poor LV function (J. Bax)
Vascular complications and women (B. Ahmed)
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Revascularization In The Very Elderly
Cindy L. Grines, ., .
William Beaumont Hospital
Royal Oak, Michigan, .
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In-Hospital Complications After PCI: Effect of Age
Bachelor, JACC 2000;36:723
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Complications* After Elective PCI in Octogenarians
Death
MI
Q-wave
Stroke
Death/MI/
CVA
Renal
failure
Vascular
complications
Bachelor. JACC 2000;36:723
* p < .001 for all complications
*
*
*
*
*
*
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Safety Concerns in ACS Care: The Elderly Bleed More
Yang et al J Am Coll Cardiol 2005;46:1490-5
0
5
10
15
20
<55
55-64
65-74
≥75
Age group (years)
Blood Transfusion (%)
<55
55-64
65-74
≥75
Age group (years)
# of Anti-platelet/coagulants Used*
1 Agent Used
2 Agents Used
≥3 Agents Used
* Aspirin, Clopidogrel, UFH, LMWH, GP IIb/IIIa Inhibitor
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Acute Coronary Syndrome Registries
Elderly patients
Vague symptoms
More co-morbidities
Less likely to receive medical treatments of proven benefit
Less likely to receive cath or revascularization
Worse outcomes
PRAIS-UK, Age and Aging 2005;34:61-66
CRUSADE, JAMA 2004;292:2096-104
GRACE, Am Heart J 2005;149:67-73
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TACTICS-TIMI 18: Elderly ACS Patients Benefit the Most From Early Invasive Strategy
Ann Intern Med 2004;141:186-195
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AMI in the Elderly
Advanced age strongest determinant of early and late mortality
80% of all deaths are in patients > 60 years old
risk of intracranial bleeding
Minority receive lytic therapy (10% of patients > 65 years old)
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< 75 yrs (n=2580)
75 yrs (n=452)
p < .001
p = .01
p < .001
p < .001
p < .001
p < .001
DeGeare. AJC 2000