Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.
OBJECTIVE
It is still unknown whether impaired myocardial perfusion helps to explain the higher mortality observed with ageing in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty.


RESULTS
In 1548 consecutive patients with STEMI treated with primary angioplasty, myocardial perfusion was evaluated by myocardial blush grade (MBG) and ST-segment resolution. All clinical and follow-up data were prospectively collected. Advanced age was associated with a significantly higher clinical and angiographic risk profile. We found a linear relationship between increasing age, decreased myocardial perfusion, and higher 1-year mortality. After adjustment for baseline potential confounding variables, increased age was still significantly associated with impaired myocardial blush (MBG 0-1) (P=0.028), and ST-segment resolution (<50%) (P=0.007). At multivariable analysis both age (P<0.0001) and poor myocardial perfusion (P<0.0001) were independent predictors of 1-year mortality.


CONCLUSIONS
This study shows that impaired reperfusion is an additional determinant of the poor outcome observed with advanced age in patients with STEMI undergoing mechanical revascularization.
De Luca
Giuseppe
G
Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Groot Weezelanden 20, 8011 JW Zwolle, The Netherlands.
van 't Hof
Arnoud W J
AW
Ottervanger
Jan Paul
JP
Hoorntje
Jan C A
JC
Gosselink
A T Marcel
AT
Dambrink
Jan-Henk E
JH
de Boer
Menko-Jan
MJ
Suryapranata
Harry
H
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis