Age and comorbidity in acute myocardial infarction: a report from the AMI-Florence Italian registry.
A total of 930 cases of ST-segment elevation myocardial infarction were prospectively recorded in the Florence health district. Factors influencing survival or those associated with use of revascularization (percutaneous coronary intervention, 91%) were identified through multivariate analyses (Cox and logistic regression, respectively). The independent protective effect of coronary reperfusion therapy (CRT) was evident at 36 months (39% reduction in the risk of death). After adjusting for all multivariate predictors, CRT use was 63% less likely at age 85 years and older than at under 65 years (p<0.001). Since beyond advancing age, comorbidity appeared to be associated with a reduced chance of CRT, three chronic comorbidity score categories were calculated using information on past medical history. Increased 1-year mortality in patients with higher comorbidity score categories derives, at least in part, from underutilization of CRT. Results confirm that although they might potentially benefit from CRT during ST-segment elevation myocardial infarction, older and frail patients are excluded from CRT, even when eligible.
Balzi
Daniela
D
Epidemiology Unit, Local Health Unit 10, Florence, Italy.
Barchielli
Alessandro
A
Buiatti
Eva
E
Franceschini
Caterina
C
Mangani
Irene
I
Del Bianco
Laura
L
Monami
Matteo
M
Valente
Serafina
S
Gensini
Gian Franco
GF
Marchionni
Niccolò
N
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D015897:Comorbidity; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion; D011379:Prognosis; D012042:Registries