[Acute myocardial infarction in patients over 70 years of age treated by immediate primary angioplasty].
Twenty consecutive patients aged over 70, admitted for acute myocardial infarction, underwent coronary arteriography within less than 6 hours after the onset of pain to confirm the diagnosis and determine the indications for other than thrombolytic reperfusion treatment, the risk of thrombolysis seeming theoretically prohibitive. In all cases, the artery responsible was found to be obstructed and, based upon this criterion, primary reperfusion angioplasty was performed. The criterion for success of angioplasty was the reappearance of distal flow (grade > 1 of the TIMI classification--Thrombolysis in Myocardial Infarction). The reperfusion rate obtained by angioplasty was 85%. Follow-up coronary arteriography during hospitalisation (between D10 and D15) in 17 patients revealed neither restenosis nor re-occlusion. In case of successful reperfusion, left ventricular ejection fraction improved by 16% (in absolute values). Hospital mortality was 15% (6 patients were in cardiogenic shock from the time of admission). Mortality (after a follow-up of 27.3 +/- 17.5 months) was 20%. Complications of the procedure during the acute phase included one femoral hematoma and one moderate coronary dissection, with an uncomplicated outcome. Angioplasty is an effective reperfusion method in patients aged over 70, and is an alternative to thrombolysis which, in this age group, is accompanied by a risk of hemorrhagic complications, cerebral in particular. Thus angioplasty can be suggested as first line treatment in elderly patients provided they have been admitted to a unit where operational cardiology is available on a continuous basis.
Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre.
M E
ME
Moulichon
J M
JM
Mossard
R
R
Arbogast
J
J
Sacrez
A
A
Koegler
G
G
Roul
P
P
Bareiss
A
A
Sacrez
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003362:Cost-Benefit Analysis; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy
Infarctus du myocarde aigu chez les patients de plus de 70 ans traités par angioplastie primaire immédiate.