多病共患的老年急性冠状动脉综合征患者抗栓治疗情况及预后分析  

Multimorbidity in elderly patients with acute coronary syndrome:insights from BleeMACS registry

作　　者：严研[1] 公威 王晓[1] 范婧尧 聂绍平[1] Yan Yan;Gong Wei;Wang Xiao;Fang Jingyao;Nie Shaoping(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科冠心病中心,北京100029

出　　处：《中华心血管病杂志》2022年第5期443-449,共7页Chinese Journal of Cardiology

基　　金：国家重点研发项目(2020YFC2004800)。

摘　　要：目的探讨多病共患对老年急性冠状动脉综合征(acute coronary syndrome,ACS)患者抗栓药物使用及预后的影响。方法基于国际多中心、回顾性ACS患者的临床队列(BleeMACS),分析多病共患对老年ACS患者抗栓治疗情况及预后的影响。本研究将比较不同共病情况患者的基本临床特征、抗栓药物应用情况,以及1年随访的终点事件的发生率。结果BleeMACS研究在2003至2014年纳入来自10个国家15家医院的7120例老年ACS患者(年龄≥65岁)。根据共病情况,将患者分为无共病组(729例)、合并1种共病组(1594例)、2种共病组(2156例)和≥3种共病组(2641例)。合并共病患者的年龄、女性与非ST段抬高型急性冠脉综合征占比、血肌酐水平以及应用药物洗脱支架的比率均明显高于无共病患者。与无共病组相比,共病越多的患者应用口服抗凝药比率越高(5.8%比6.4%、7.3%、9.0%,趋势P<0.01)、应用氯吡格雷比率越低(91.9%比89.7%、87.9%、88.6%,趋势P=0.01)。1年随访可见,与无共病组相比,合并1种共病(HR=1.18,95%CI:0.86~1.64),2种共病(HR=1.49,95%CI:1.10~2.02),≥3种共病(HR=2.74,95%CI:2.06~3.66)净临床不良事件发生风险更高(P<0.01)。共病未增高颅内、胃肠道、泌尿、生殖、肺、耳鼻喉、血管等部位的出血发生率,趋势检验P值均>0.05。结论老年ACS患者普遍存在多病共患情况,共病影响老年ACS患者的抗栓药物的应用种类,并且减低1年临床净获益。Objective To assess the prevalence,pattern and outcome of multimorbidity in elderly patients with acute coronary syndrome(ACS).Methods Secondary analysis was performed based on the data from the BleeMACS registry,which was conducted between 2003 and 2014.We stratified elderly patients(≥65 years)according to their multimorbidity.Multimorbidity was defined as two or more chronic diseases in the same individual.Kaplan-Meier methods were used to estimate 1 year event rates for each endpoint,and comparisons between the study groups were performed using the log-rank test.The primary endpoint was net adverse clinical events(NACE),which is a composite of all-cause mortality,myocardial infarction,or bleeding.Results Of 7120 evaluable patients,6391(89.8%)were with morbidity(1594 with 1,2156 with 2,and 2641 with≥3 morbidity).Patients with morbidity were older,percent of female sex and non-ST-elevation acute coronary syndromes and implantation rate with drug-eluting stents and blood creatine level were higher compared to patients without morbidity.Compared with the patients without morbidity,the proportion of participants with oral anticoagulant increased in proportion to increased number of morbidities(5.8%vs.6.4%with 1 morbidity,7.3%with 2 morbidities,9.0%with≥3 morbidities,P trend<0.01)and the proportion of participants with clopidogrel prescription decreased in proportion to increased number of morbidity(91.9%vs.89.7%with 1 morbidity,87.9%with 2 morbidities,88.6%with≥3 morbidities,P trend=0.01).During 1 year follow-up,compared with those with no morbidity,the hazard ratio(HR)and 95%confidence interval(CI)of risk of NACE for those with 1,2,and≥3 morbidities was 1.18(0.86-1.64),1.49(1.10-2.02),and 2.74(2.06-3.66),respectively(P<0.01).Multimorbidity was not associated with an increased risk of bleeding of various organs(P>0.05).Conclusion Multimorbidity is common in elderly patients with ACS.These patients might benefit from coordinated and integrated multimorbidity management by multidisciplinary teams.

关 键 词：急性冠状动脉综合征 共病现象 老年医学 抗栓治疗 预后 

分 类 号：R541.4[医药卫生—心血管疾病]