关键词: 非ST段抬高型心肌梗死, 老年人, 治疗, 保守治疗, 影响因素分析

Abstract: Background　Older age is an independent risk factor of the onset and poor prognosis of acute non-ST-segment elevation myocardial infarction （NSTEMI） patients. Although older age is not alimitingfactor for reperfusion therapy theoretically，the prevalence of reperfusion therapy in Chinese older NSTEMI patients is far lower than that of those in developed countries，so it is necessary to analyze the factors associated with inability to receive reperfusion therapy in such patients. Objective　To analyze the prevalence and associated factors of invasive therapy in patients aged 75 and over with NSTEMI.Methods　Five hundred and thirty-sixcases with an admission diagnosis of NSTEMI were selected from Hebei General Hospital from November 2016 to August 2019. The following variables were collected，including age，sex，Killip class >Ⅱ，admission blood pressure and heart rate，medical history （including history of old myocardial infarction，PCI history，grade 2-3hypertension，diabetes，hyperlipidemia，chronic kidney disease，anemia），smoking，drinking，GRACE score，left ventricularejection fraction，white blood cell count，hemoglobin，platelet count，albumin，fasting blood glucose，serum creatinine，glomerular filtration rate，total cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein and treatment strategies. The differences between patients under 75 years of age and those aged 75 and over were compared after being matched using the propensity score. Subgroup differences were analyzed between those with interventional therapy and with conservative treatment in the 75-and-over age group. Multivariate Logistic regression analysis was used to explore the influencing factors of invasive treatment. Results　After propensity-score matching，it was found that patients under 75 years of age had higher prevalence of interventional therapy （P<0.05）. Compared with conservative treatment subgroup，interventional therapy subgroup had decreased GRACE score and serum creatinine，and elevated total cholesterol and albumin（P<0.05）. Multivariate logistic regression analysis showed systolic blood pressure〔OR=1.022，95%CI（1.002，1.044），P=0.034〕，GRACE score 〔OR=1.015，95%CI（1.001，1.030），P=0.031〕，albumin level〔OR=0.86，95%CI（0.763，0.969），P=0.013〕，serum creatinine level〔OR=1.018，95%CI（1.000，1.035），P=0.044〕 were associated with interventional therapy. Conclusion　The rate of interventional therapy in elderly patients（age≥75 years old）with NSTEMI is lower. The possibility of receiving invasive therapy may be increased with lower blood pressure and higher albumin，and may be reduced with higher GRACE score and serum creatinine level.

Key words: Non-ST elevated myocardial infarction, Aged, Therapy, Conservative treatment, Root cause analysis