Clinical characteristics and early outcomes of very elderly patients in the reperfusion era.
BACKGROUND
Not much data is available regarding "real-world" clinical experience of very elderly patients with acute myocardial infarction (AMI) in the reperfusion era.


METHODS
We reviewed 483 patients (26%) between the ages of 75 and 85 from the 1855 patients with AMI. We analyzed 264 patients treated with reperfusion therapy (55%) and 219 patients treated with conservative therapy (45%) on their clinical characteristics and early outcomes.


RESULTS
Patients treated with reperfusion therapy were slightly younger (79.0 vs. 80.0 years, P=0.01), presented earlier (205 vs. 400 minutes, P<0.01) and had higher peak creatine kinase values (2634 vs. 1407 IU/l, P<0.01) than those treated with conservative therapy. Other clinical profiles including sex, prior myocardial infarction, hypertension, diabetes, and infarct location were similar to each other. There was a 92% success for reperfusion therapy. The incidence of recurrent ischemia, cardiac rupture, and cerebral hemorrhage was not significantly different between the two groups. In-hospital mortality in this study was 20.5%. In-hospital mortality was not significantly different between the two groups (19% vs. 23%, P=0.25). The multivariate analysis showed that age, infarct location, and Killip class were correlated to in-hospital mortality. The leading cause of in-hospital death was pump failure.


CONCLUSIONS
Older age and late presentation were correlated to conservative therapy in very elderly patients with AMI. Early outcomes were similar between the two treatment groups. In-hospital mortality seemed to be associated with impaired myocardial reserve.
Yagi
Masahiro
M
The Cardiovascular Center, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto 861-4193, Japan. yagichada@cam.hi-ho.ne.jp
Nakao
Koichi
K
Honda
Takashi
T
Tsurumi
Yukio
Y
Kasanuki
Hiroshi
H
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D016017:Odds Ratio; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome