朱永翔,常尚,李征,李谦,张瑶俊

• 1:徐州市第三人民医院心内科

摘要(Abstract)：

高龄非ST段抬高型急性冠状动脉综合征患者的治疗策略选择一直是临床医师关心的问题。因此本文对这类患者接受有创或保守治疗的风险及获益比、有创治疗的时机确立、抗栓治疗的药物选择等研究进展进行综述。

关键词(KeyWords)： 高龄;急性冠状动脉综合征;治疗策略

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 朱永翔,常尚,李征,李谦,张瑶俊

参考文献(References)：

• [1]Fox KAA,Clayton TC,Damman P,et al.Long-term outcome of a routine versus selective invasive strategy in patients with nonST-segment elevation acute coronary syndrome a meta-analysis of individual patient data.J Am Coll Cardiol,2010,55(22):2435-2445.
• [2]Amsterdam EA,Wenger NK,Brindis RG,et al.2014 AHA/ACCguideline for the management of patients with non-ST-elevation acute coronary syndromes:executive summary:a report of the American College of Cardiology/American Heart Association task force on practice guidelines.Circulation,2014,130(25):2354-2394.
• [3]Collet JP,Thiele H,Barbato E,et al.2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J,2021,42(14):1289-1367.
• [4]中华医学会心血管病学分会，中华心血管病杂志编辑委员会.非ST段抬高型急性冠状动脉综合征诊断和治疗指南（2016）.中华心血管病杂志，2017,45(5):359-376.
• [5]Angeli F,Cavallini C,Verdecchia P,et al.A risk score for predicting 1-year mortality in patients≥75 years of age presenting with non-ST-elevation acute coronary syndrome.Am J Cardiol,2015,116(2):208-213.
• [6]Savonitto S,Cavallini C,Petronio AS,et al.Early aggressive versus initially conservative treatment in elderly patients with nonST-segment elevation acute coronary syndrome:a randomized controlled trial.JACC Cardiovasc Interv,2012,5(9):906-916.
• [7]Sanchis J,Nú?ez E,Barrabés JA,et al.Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction.Eur J Intern Med,2016,35:89-94.
• [8]LlaóI,Ariza-SoléA,Sanchis J,et al.Invasive strategy and f railty in very elderly patients with acute coronary syndromes.Euro Intervention,2018,14(3):e336-e342.
• [9]Plakht Y,Shiyovich A,Gilutz H.Predictors of long-term (10-year)mortality postmyocardial infarction:age-related diff erences.Soroka acute myocardial infarction (SAMI) project.J Cardiol,2015,65(3):216-223.
• [10]Rea?o JDP,Shiu LAB,Miralles KV,et al.A systematic review and meta-analysis on the effectiveness of an invasive strategy compared to a conservative approach in patients>65 years old with non-ST elevation acute coronary syndrome.PLo S One,2020,15(2):e0229491.
• [11]Tegn N,Abdelnoor M,Aaberge L,et al.Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study):an open-label randomised controlled trial.Lancet,2016,387(10023):1057-1065.
• [12]Conti E,Musumeci MB,Desideri JP,et al.Outcomes of early invasive treatment strategy in elderly patients with non-ST elevation acute coronary syndromes.J Cardiovasc Med (Hagerstown),2016,17(10):736-743.
• [13]Bardaji A,Barrabés JA,Ribera A,et al.Revascularisation in older adult patients with non-ST-segment elevation acute coronary syndrome:effect and impact on 6-month mortality.Eur Heart JAcute Cardiovasc Care,2020,9(4):358-366.
• [14]Wei CC,Lee SH.Predictors of mortality in elderly patients with non-ST elevation acute coronary syndrome-data from taiwan acute coronary syndrome full spectrum registry.Acta Cardiol Sin,2017,33(4):377-383.
• [15]Kaura A,Sterne JA,Trickey A,et al.Invasive versus non-invasive management of older patients with non-ST elevation myocardial infarction (SENIOR-NSTEMI):a cohort study based on routine clinical data.Lancet,2020,396(10251):623-634.
• [16]Gnanenthiran SR,Kritharides L,D’Souza M,et al.Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly:a meta-analysis.Heart,2017,103(24):1962-1969.
• [17]Ma W,Liang Y,Zhu J.Early invasive versus initially conservative strategy in elderly patients older than 75 years with non-ST-elevation acute coronary syndrome:a meta-analysis.Heart Lung Circ,2018,27(5):611-620.
• [18]Bagnall AJ,Goodman SG,Fox KA,et al.Influence of age on use of cardiac catheterization and associated outcomes in patients with non-ST-elevation acute coronary syndromes.Am J Cardiol,2009,103(11):1530-1536.
• [19]Buber J,Goldenberg I,Kimron L,et al.One-year outcome following coronary angiography in elderly patients with non-ST elevation myocardial infarction:real-world data from the acute coronary syndromes israeli survey (ACSIS).Coron Artery Dis,2013,24(2):102-109.
• [20]Damman P,Clayton T,Wallentin L,et al.Eff ects of age on longterm outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes:a collaborative analysis of individual data from the FRISCII-ICTUS-RITA-3 (FIR) trials.Heart,2012,98(3):207-213.
• [21]Angeli F,Verdecchia P,Savonitto S,et al.Early invasive versus selectively invasive strategy in patients with non-ST-segment elevation acute coronary syndrome:impact of age.Catheter Cardiovasc Interv,2014,83(5):686-701.
• [22]Leng W,Yang J,Fan X,et al.Contemporary invasive management and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction in China:findings from China acute myocardial inf arction (CAMI) registry.Am Heart J,2019,215:1-11.
• [23]Roffi M,Patrono C,Collet JP,et al.2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:task f orce f or the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J,2016,37(3):267-315.
• [24]杨跃进，杨进刚，袁晋青，等.高龄老年（≥75岁）急性冠状动脉综合征患者规范化诊疗中国专家共识.中国循环杂志，2018,33(8):732-750.
• [25]Tersalvi G,Biasco L,Cioffi GM,et al.Acute coronary syndrome,antiplatelet therapy,and bleeding:a clinical perspective.J Clin Med,2020,9(7):2064.
• [26]Husted S,James S,Becker RC,et al.Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes:a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial.Circ Cardiovasc Qual Outcomes,2012,5(5):680-688.
• [27]Lindholm D,Varenhorst C,Cannon CP,et al.Ticagrelor vs.clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization:results f rom the PLATO trial.Eur Heart J,2014,35(31):2083-2093.
• [28]Wang H,Wang X.Effi cacy and safety outcomes of ticagrelor compared with clopidogrel in elderly Chinese patients with acute coronary syndrome.Ther Clin Risk Manag,2016,12:1101-1105.
• [29]Gimbel M,Qaderdan K,Willemsen L,et al.Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with nonST-elevation acute coronary syndrome (POPular AGE):the randomised,open-label,non-inferiority trial.Lancet,2020,395(10233):1374-1381.
• [30]Szummer K,Montez-Rath ME,Alfredsson J,et al.Comparison between ticagrelor and clopidogrel in elderly patients with an acute coronary syndrome:insights from the SWEDEHEART registry.Circulation,2020,142(18):1700-1708.
• [31]Xue HJ,Shi J,Liu B,et al.Comparison of half-and standard-dose ticagrelor in Chinese patients with NSTE-ACS.Platelets,2016,27(5):440-445.