80 Yaş üzeri ST Segment Yükselmesiz Miyokart Enfarktüsü Hastalarında İnvaziv ve Konservatif Tedavinin Hastane içi Mortalite üzerine etkilerinin karşılaştırılması

Abstract

Amaç: Bu çalışmada, 80 yaş ve üzeri ST-segment elevasyonsuz miyokard enfarktüsü (NSTEMI) hastalarında invaziv ve konservatif tedavi stratejilerinin hastane içi mortalite üzerine etkisi araştırıldı. Yöntemler: Ocak 2019 – Mayıs 2025 tarihleri arasında Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde NSTEMI tanısıyla yatırılan ≥80 yaşındaki hastalar retrospektif olarak değerlendirildi. Dahil edilme ve dışlama kriterleri uygulandıktan sonra 148 hasta çalışmaya alındı. Hastalar tedavi stratejisine göre invaziv ve konservatif olarak iki gruba ayrıldı. Demografik, klinik, ekokardiyografik ve laboratuvar bulguları ile hastane içi sonlanımlar karşılaştırıldı. Bulgular: Toplam 148 hasta çalışmaya dâhil edildi; bunların 90’ı (%62,1) invaziv, 58’i (%37,9) konservatif tedavi grubundaydı. Tüm kohortun medyan yaşı 86 (80–105) yıl olup, %44,6’sı kadındı. Konservatif grup, invaziv gruba göre daha ileri yaşta (p<0,001) ve daha düşük ejeksiyon fraksiyonuna (EF) sahipti (%45 vs. %50, p=0,010). Ayrıca konservatif grupta üre (p=0,012), kreatinin (p=0,004) ve AST (p=0,002) düzeyleri daha yüksekti. Hastane içi mortalite açısından her iki grup arasında anlamlı fark izlenmedi [10 (%17,2) vs. 7 (%7,4), p=0,058]. Çalışmamızda, lojistik regresyon analizi ile hastane içi mortalitede bazı öngördürücüler tespit ettik. Bunlar; troponin düzeyindeki artış (p=0,048), EF değerinde düşüş (p=0,010) ve kontrast ilişkili nefropati (CIN) gelişmesiydi (p=0,006). Sonuç: ≥80 yaş NSTEMI hastalarında tedavi stratejileri arasında hastane içi mortalite farkı izlenmemekle birlikte, düşük ejeksiyon fraksiyonu, yüksek troponin düzeyleri ve kontrast ilişkili nefropati mortaliteyi öngören bağımsız belirteçlerdir.

Keywords

• NSTEMI
• ileri yaş
• invaziv tedavi
• konservatif tedavi
• mortalite

Comparison of Invasive and Conservative Treatment Strategies on In-Hospital Mortality in Patients Aged 80 Years And Older With Non-ST-Elevation Myocardial Infarction

Abstract

Objective: This study aimed to investigate the impact of invasive versus conservative treatment strategies on in-hospital mortality in patients aged ≥80 years with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: Between January 2019 and May 2025, patients aged ≥80 years who were hospitalized with a diagnosis of NSTEMI at Koşuyolu High Specialization Training and Research Hospital were retrospectively evaluated. Following the application of inclusion and exclusion criteria, 148 patients were enrolled. Patients were divided into invasive and conservative groups according to treatment strategy. Demographic, clinical, echocardiographic, and laboratory parameters, as well as in-hospital outcomes, were compared. Results: A total of 148 patients were included in the study, with 90 (62.1%) in the invasive treatment group and 58 (37.9%) in the conservative group. The median age of the patients was 86 years, and 44.6% were female. Patients in the conservative group were significantly older (p<0.001) and had a lower ejection fraction (EF) compared to the invasive group (45% vs. 50%, p=0.010). Additionally, levels of urea (p=0.012), creatinine (p=0.004), and AST (p=0.002) were significantly higher in the conservative group. There was no statistically significant difference in in-hospital mortality between the two groups [10 (17.2%) vs. 7 (7.4%), p=0.058]. The logistic regression analysis revealed multiple independent predictors of in-hospital mortality: elevated troponin levels (p=0.048), reduced EF (p=0.010), and the presence of contrast-induced nephropathy (CIN) (p=0.006). Conclusion: Although no significant difference in in-hospital mortality was observed between invasive and conservative treatment strategies in ≥80-year-old NSTEMI patients, reduced EF, elevated troponin levels, and the development of CIN were identified as independent predictors of mortality.

Keywords

• NSTEMI
• elderly
• invasive strategy
• conservative strategy
• in-hospital mortality.

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