Особенности лечения острого коронарного синдрома у пациентов старческого возраста (по данным Федерального регистра острого коронарного синдрома)
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Цель. В настоящем исследовании изучалось качество медицинской помощи больным с острым коронарным синдромом (ОКС) старческого возраста и соответствие проводимого лечения современным рекомендациям. Данные экспортированы из системы Федерального регистра ОКС.
Материалы и методы. Проанализированы истории болезни 33 893 пациентов с ОКС, внесенных в систему регистра ОКС за период с 01.01.2016 по 31.12.2016 г. Проводилось сравнение качества медицинской помощи у пациентов с ОКС старческого возраста (75 лет и старше, n=8773) и у более молодых пациентов.
Результаты. Результаты исследования продемонстрировали, что у больных старческого возраста при сравнении с более молодыми достоверно чаще наблюдаются коморбидные состояния, а также достоверно выше риск госпитальной и 6-месячной смерти, рассчитанный по шкале GRACE.
Заключение. Больным старческого возраста с ОКС практически в два раза реже проводятся чрескожные коронарные вмешательства, чем у более молодых, что ухудшает прогноз у этих больных и увеличивает летальность.
Ключевые слова: острый коронарный синдром, регистр острого коронарного синдрома, старческий возраст.
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The frequency of cardiovascular diseases is increasing progressively with age, and the global aging of the population poses the problem of treatment of patients of older age groups in a row with other relevant medical and socio-economic problems.
Aim. In the present study was to investigate the quality of medical care for patients with acute coronary syndrome (ACS) old age and compliance of the treatment current guidelines. The data is exported from the system of the Federal register OKS.
Materials and methods. Analyzed medical history 33 893 patients with ACS entered in the system registry of ACS for the period from 01.01.2016 to 31.12.2016. a comparison was made of the quality of care in patients with ACS elderly (75 years and older, n=8773) and in younger patients.
Results. The results of the study showed that in patients of senile age, when compared with younger patients, comorbid conditions are significantly more often observed, as well as a significantly higher risk of hospital and 6-month death, calculated on the GRACE scale.
Conclusion. Patients of senile age with ACS are almost twice less likely to undergo percutaneous coronary interventions than younger ones, which worsens the prognosis in these patients and increases mortality.
Keywords: acute coronary syndrome, register of acute coronary syndrome, senile age.
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1. Alexander K, Newby L, Cannon C et al. Acute Coronary Care in the Elderly, Part I: Non-ST-Segment-Elevation Acute Coronary Syndromes: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology. Circulation. 2007; 115 (19): 2549-2569. https://doi:10.1161/circulationaha.107.182615
2. Alexander K, Newby L, Armstrong P et al. Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology. Circulation. 2007; 115 (19): 2570-2589. https://doi:10.1161/circulationaha.107.182616
3. De Luca L, Olivari Z, Bolognese L et al. A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units. Open Heart. 2014; 1 (1): e000148. doi:10.1136/openhrt-2014-000148
4. Mozaffarian D, Benjamin E J, Go A.S et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015; 131(4): 29-322. https://doi.org/10.1161/CIR.000000 0000000152
5. Avezum A, Makdisse M, Spencer F et al. Impact of age on management and outcome of acute coronary syndrome: Observations from the global registry of acute coronary events (GRACE). American Heart Journal. 2005; 149 (1): 67-73. https://doi:10.1016/j.ahj.2004.06.003
6. Lee P. Representation of Elderly Persons and Women in Published Randomized Trials of Acute Coronary Syndromes. JAMA. 2001; 286 (6): 708. https://doi:10.1001/jama.286.6.708
7. Zaman M, Stirling S, Shepstone L et al. The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP). European Heart Journal. 2014; 35 (23): 1551-1558. https://doi:10.1093/eurheartj/ehu039
8. Savonitto S, Cavallini C, Petronio A et al. Early Aggressive Versus Initially Conservative Treatment in Elderly Patients with Non–ST-Segment Elevation Acute Coronary Syndrome. JACC: Cardiovascular Interventions. 2012; 5 (9): 906-916. https://doi:10.1016/j.jcin.2012.06.008
9. Barywani S, Li S, Lindh M et al. Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality. Clinical Interventions in Aging. 2015:1547. https://doi:10.2147/cia.s89127
10. [Society of specialists in emergency cardiology. Guidelines and recommendations. http://acutecardio.ru/article/catalog/3. The link is active on 01.10.2017. (In Russ.)].
11. O'Gara P, Kushner F, Ascheim D et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary. Journal of the American College of Cardiology. 2013; 61 (4): 485-510. https://doi:10.1016/j.jacc.2012.11.018
12. Steg P, James S, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal. 2012; 33 (20): 2569-2619. https://doi:10.1093/eurheartj/ehs215
13. Windecker S., Kolh Ph., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2014; 35 (37): 2541-2619. https://doi:10.1093/eurheartj/ehu278
14. [Dovgalevsky P, Gridnev V, Oshchepkova E et al. Federal Registry of Acute Coronary Syndrome user guide. Cardio-IT. 2014; 1 (2): 0203. (In Russ.)]. https://doi:10.15275/cardioit.2014.0203
15. Fox K, FitzGerald G, Puymirat E et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014; 4 (2): e004425. https://doi:10.1136/ bmjopen-2013-004425
16. Veerasamy M, Edwards R, Ford G et al. Acute Coronary Syndrome Among Older Patients. Cardiology in Review. 2015; 23 (1): 26-32. https://doi:10.1097/crd.0000000000000016
17. Roffi M, Patrono C, Collet J et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2015; 37 (3): 267-315. https://doi:10.1093/eurheartj/ehv320
18. Amsterdam E, Wenger N, Brindis R et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Journal of the American College of Cardiology. 2014; 64 (24): e139-e228. https://doi:10.1016/j.jacc.2014.09.017
19. [Posnenkova OM, Kiselev AR, Gridnev VI, Popova YuV, Dovgalevskyi PYa, Oshchepkova EV. Assessment of myocardial reperfusion quality in patients with acute coronary syndrome and ST segment elevation, based on the criteria by the American College of Cardiology / American Heart Association. Cardiovascular Therapy and Prevention. 2013; 12 (5): 40-44. (In Russ.)].
20. [Oshchepkova E, Dmitriev V. Life Threatening Complications in Patients With ST-Elevation Acute Coronary Syndrome-Dependence on Reperfusion Interventions (Data of Federal Register of Patients With Acute Coronary Syndrome). Kardiologiia. 2016; 56 (4): 32-35. (In Russ.)]. https://doi:10.18565/cardio.2016.4.32-35
Институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава Российской Федерации, Москва, Россия
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E.V. OCSHEPKOVA, O.V. SAGAYDAK, I.E. CHAZOVA
Russian Cardiology Research Center, Institute of clinical cardiology named by A.L. Myasnikov, Moscow, Russia