Primary Percutaneous Coronary Intervention in Elderly Patients With Acute Myocardial Infarction　― An Analysis From a Japanese Nationwide Claim-Based Database ―

• Uemura Shiro

  Cardiovascular Medicine, Kawasaki Medical School

• Okamoto Hiroshi

  Cardiovascular Medicine, Kawasaki Medical School

• Nakai Michikazu

  National Cerebral and Cardiovascular Center

• Nishimura Kunihiro

  National Cerebral and Cardiovascular Center

• Miyamoto Yoshihiro

  National Cerebral and Cardiovascular Center

• Yasuda Satoshi

  National Cerebral and Cardiovascular Center

• Tanaka Nobuhiro

  Department of Cardiology, Tokyo Medical University Hachioji Medical Center

• Kohsaka Shun

  Department of Cardiology, Keio University School of Medicine

• Kadota Kazushige

  Department of Cardiology, Kurashiki Central Hospital

• Saito Yoshihiko

  Department of Cardiology, Nara Medical University

• Tsutsui Hiroyuki

  Department of Cardiovascular Medicine, Kyusyu University

• Komuro Issei

  Department of Cardiovascular Medicine, The University of Tokyo

• Ikari Yuji

  Department of Cardiovascular Medicine, Tokai University School of Medicine

• Ogawa Hisao

  National Cerebral and Cardiovascular Center

• Nakamura Masato

  Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine

抄録

Background:Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear. Methods and Results:The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI. Conclusions:Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

収録刊行物

• Circulation Journal

  Circulation Journal 83 (6), 1229-1238, 2019-05-24

  一般社団法人 日本循環器学会

キーワード

• Acute myocardial infarction
• Elderly
• Outcome
• Primary percutaneous coronary intervention

詳細情報

• CRID: 1390564238093599616
• NII論文ID: 130007652783
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-19-0004
• ISSN: 13474820
• ISSN: 13469843
• NDL書誌ID: 029688099
• PubMed: 31019165
• Web Site: http://id.ndl.go.jp/bib/029688099
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I029688099
• Web Site: https://www.jstage.jst.go.jp/article/circj/83/6/83_CJ-19-0004/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2020074758
• 本文言語コード: en
• データソース種別:
  • JaLC
  • NDL
  • Crossref
  • PubMed
  • CiNii Articles
  • KAKEN
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