Ferhat IŞIK, Abdurrahman AKYÜZ, Ümit İNCİ, Habib ÇİL

ST Segment Yükselmesiz Akut Koroner Sendromlu Yaşlı Hastalarda Girişimsel Tedavi ile Konservatif Tedavinin Altı Aylık Dönemde Mortalite Üzerine Etkilerinin Karşılaştırılması

Giriş: Çalışmamızın amacı, ST segment yükselmesiz akut koroner sendrom (NSTEAKS) tanısı ile hastaneye yatırılan yaşlı (65 yaş ve üstü) hastalarda girişimsel tedavi ve konservatif tedavi gruplarının 6 aylık dönemde mortalitelerini karşılaştırmaktır.Yöntemler: Çalışmamızda NSTEAKS tanısı ile hastaneye yatırılan 65 yaş ve üstü ardışık 300 hasta retrospektif olarak incelendi. Hastane kayıt sisteminden tüm hastaların verilerine ulaşıldı. Hastalar girişimsel tedavi alanlar ve konservatif tedavi verilenler olarak iki gruba ayrıldı. Ayrıca 6 aylık süreçte ölen hastalar ve yaşayan hastalar, iki grup olarak karşılaştırıldı. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 74.72 ± 6.42 olup 157’si (%52) kadındı. Girişimsel ve konservatif tedavi grubunun yaş ortalamaları benzerdi (73.67 ± 5.92 vs 75.77 ± 6.78, p=0.05). Çalışma popülasyonunda 6 aylık dönemde mortalite oranı %13,6 idi. Girişimsel tedavi gurubunda mortalite anlamlı olarak daha düşüktü (%8,6 vs %18,6, p= 0.018). Çalışmamızda, çok değişkenli lojistik regresyon analizi ile 6 aylık mortalitede bazı öngördürücüler tespit ettik. Bunlar; çok yüksek CRUSADE kanama riski [Odds oranı (OR): 1.911, güven aralığı (GA) %95 (1.964 - 28.186), p= 0.030)], konservatif tedavi stratejisinin benimsenmesi [OR: 1.127, GA %95 (0.131 – 0.799), p= 0.014)] ve kardiyak biyobelirteçlerinin (troponin) pozitifliğiydi [OR: 1.837, GA %95 (1.928 – 25.391), p= 0.030)].Sonuç: Yaşlı NSTEAKS hastalarında 6 aylık mortaliteyi öngörmede konservatif tedavi stratejisi bağımsız bir prediktördür. Başka ifade ile girişimsel tedavi yapılması, yaşlı hastalarda mortaliteyi azaltmıştır. Bu sonuçlar yaşlı hastaların da kapsamlı bir değerlendirmeden sonra girişimsel tedaviden fayda görebileceğini göstermektedir.

Comparison of the Effects of Interventional Treatment and Conservative Treatment on Mortality in Six Months in Elderly Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Introduction: We aimed to compare 6 month-mortality of elderly patients (≥ 65 years of age) presented with non-ST segment elevation acute coronary syndrome (NSTEACS) treated with interventional methods and that of patients treated by conservative approach. Methods: A total of 300 consecutive patients aged 65 and older presented NSTEACS were enrolled to this retrospectively designed study. Data of all patients were reached from hospital records. Patients were divided into two groups as interventional and conservative treatment. İn addition patients who died during the 6-month period and who survived were compared in two groups. Results: Mean age of the study population was 74.72 ± 6.42 years, and 157 (52%) of them were female. The average age of interventional and conservative treatment group was similar (73.67 ± 5.92 vs 75.77 ± 6.78, p= 0.05). Six monthmortality of study population was 13.6%, while this was lower in patients treated by interventional approach (8.6 % vs. 18.6 %, p= 0.018). The predictors of 6 month-mortality were found as high CRUSADE bleeding risk [OR (Odds Ratio) :1.911, 95% confidence interval (CI) (1.964 - 28.186), p= 0.030)], conservative treatment [OR :1.127, 95% CI (0.131 – 0.799), p:0.014)] and troponin positivity [OR :1.837, 95% CI (1.928 – 25.391), p= 0.030)]. Conclusion: Conservative treatment is an independent predictor for predicting 6-month mortality in elderly patients with NSTEACS. In other words, interventional treatment has reduced mortality in elderly patients. These results show that elderly patients may also benefit from interventional treatment after a comprehensive evaluation.

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