title: Primary coronary angioplasty in the elderly.
abstract: 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.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal. joanafeliciano@netcabo.pt
authors.forename: Joana
authors.initials: J
authors.lastname: Feliciano
authors.forename: António José
authors.initials: AJ
authors.lastname: Fiarresga
authors.forename: Ana Teresa
authors.initials: AT
authors.lastname: Timóteo
authors.forename: Nuno
authors.initials: N
authors.lastname: Pelicano
authors.forename: Duarte
authors.initials: D
authors.lastname: Cacela
authors.forename: Rui
authors.initials: R
authors.lastname: Ferreira
authors.forename: Lurdes
authors.initials: L
authors.lastname: Ferreira
authors.forename: José Maria
authors.initials: JM
authors.lastname: Gonçalves
authors.forename: Jorge
authors.initials: J
authors.lastname: Quininha
mesh_terms: 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