Primary coronary angioplasty in the elderly.
BACKGROUND
Primary coronary angioplasty is the best therapeutic approach in acute myocardial infarction (AMI), and more so in the population aged over 75 years, in whom the hemorrhagic risk of thrombolysis becomes almost unacceptable.


OBJECTIVE
To evaluate age-related influences on clinical evolution and in-hospital mortality in patients with AMI who undergo primary percutaneous coronary interventions (PCI).


METHODS
We studied 245 consecutive patients (aged between 31 and 90, 63+/-13), who underwent primary PCI between January 2000 and December 2001. Forty-six patients (18.8%) aged over 75 years were compared with the rest. The following parameters were analyzed: risk factors for coronary artery disease including hypertension, diabetes, smoking, hypercholesterolemia and family history, previous AMI, PCI or angina, extent of coronary disease, angiographic results and in-hospital mortality.


RESULTS
Female gender was more frequent in older patients (56.5% vs. 23.1%; p<0.001) and smoking was more prevalent in the younger group (54.3% vs. 13.0%; p<0.001), as was previous AMI (p<0.05). PCI success was high in both groups (93.5% in the older population and 96.7% in the rest; p=NS), multivessel coronary disease was significantly more frequent in the elderly group (41.3% vs. 26.2%; p<0.05), and glycoprotein IIb/IIIa inhibitors were used less (80.4% vs. 91%; p<0.05). Killip class evolution was more favorable in the younger group (class I in 88.4% vs. 69.8% in older patients; p<0.001). The number of hemorrhagic complications and in-hospital mortality were higher in elderly patients (3.5% vs. 13.0%; p<0.05 and 4.5% vs. 19.6%; p<0.001, respectively).


CONCLUSIONS
Primary PCI has a similarly high success rate in elderly patients, although this age-group still has higher mortality. The increased rate of hemorrhagic complications in this population should lead to greater caution in the use of adjuvant antithrombotic drugs.
Feliciano
Joana
J
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal. joanafeliciano@netcabo.pt
Fiarresga
António José
AJ
Timóteo
Ana Teresa
AT
Pelicano
Nuno
N
Cacela
Duarte
D
Ferreira
Rui
R
Ferreira
Lurdes
L
Gonçalves
José Maria
JM
Quininha
Jorge
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013577:Syndrome