In-hospital clinical outcome in elderly patients with acute myocardial infarction treated with primary angioplasty.
BACKGROUND
The aim of the present study was to assess the early clinical outcome following primary coronary angioplasty in elderly patients (aged > or = 75 years) compared to younger patients (< 75 years).


METHODS
The study population included 655 consecutive patients (mean age 61.5 +/- 12.4 years) with acute ST-elevation myocardial infarction (MI) who underwent primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Elderly patients accounted for 14.5% (96 of 655) of all patients. Primary PCI was performed using a balloon and/or coronary stent as well as glycoprotein IIb/IIIa inhibitors. The primary endpoint was the in-hospital incidence of major adverse cardiac events (including death, stroke, reinfarction, target vessel revascularization and new onset of heart failure).


RESULTS
Elderly patients were more frequently female (48 vs 20%, p < 0.001) and had more comorbid disease (prior stroke 7.2 vs 2.5%, p < 0.05) and more extensive cardiovascular disease (previous acute MI 13.5 vs 5.5%, p < 0.05; multivessel disease 71.8 vs 44.6%, p < 0.0005) and a significantly lower ejection fraction (48 vs 50%, p < 0.05). Despite a similar rate of TIMI 0-1 flow at presentation (69 vs 74%, p = NS), a similar use of stents (84 vs 86%, p = 0.3) and of glycoprotein IIb/IIIa inhibitor infusion (19.8 vs 22.1%, p = 0.3) and a comparable angiographic residual stenosis (21 vs 19%, p = NS), the final rate of TIMI 3 flow was significantly lower in the elderly population (77.8 vs 91.4%, p < 0.001). Although the in-hospital ischemic event rates for all ages were not significantly different, the in-hospital mortality was higher in the elderly as compared with younger patients (9.3 vs 3.2%, p < 0.0001), even when the patients with cardiogenic shock at the time of admission were excluded (4.4 vs 0.9%, p < 0.0001). Furthermore, more patients aged > or = 75 had in-hospital heart failure (5.2 vs 1.8%, p < 0.05). In the whole population, multivariate analysis identified baseline Killip class III-IV as the only independent predictor of events. In elderly patients, multivariate analysis identified baseline Killip class III-IV and the time from the onset of chest pain to PCI as independent predictors of events.


CONCLUSIONS
Our data suggest that in elderly patients with acute ST-elevation MI primary PCI yields positive results: successful reperfusion can be achieved in a high proportion of elderly patients and the mortality rates are lower, than those reported in non-PCI registries. A high Killip class and late reperfusion therapy predict an unfavorable outcome in elderly patients treated with primary PCI.
Tespili
Maurizio
M
Division of Cardiology, Department of Cardiovascular Research, Ospedali Riuniti, Bergamo, Italy. tespili@katamail.com
Guagliumi
Giulio
G
Valsecchi
Orazio
O
Musumeci
Giuseppe
G
Vassileva
Angelina
A
Saino
Antonio
A
Scuri
Pier Mario
PM
Gavazzi
Antonello
A
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D010343:Patient Admission; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003402:Creatine Kinase