Effectiveness and safety of routine primary angioplasty in patients aged > or =85 years with acute myocardial infarction.
BACKGROUND
Although octogenarians constitute a fast growing portion of cardiovascular patients, few data are available on the outcome of very old patients (age >80 years) with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty.


RESULTS
Short- and long-term outcomes of 88 consecutive very old (age > or =85 years) patients with STEMI undergoing primary angioplasty were evaluated. In-hospital mortality was 17%, significantly higher in patients with cardiogenic shock (90%; p<0.001), with failure of percutaneous coronary intervention (PCI; p=0.016), with Killip class > or =III on admission (p=0.018), or with chronic renal failure (p=0.033). Major bleeding complications occurred in 11 patients (12%). Multivariable logistic regression analysis identified 3 independent predictors of in-hospital death: age > or =90 years (p=0.018), Killip > or =III on admission (p=0.018), and PCI failure (p=0.025). Multivariable logistic regression analysis identified age > or =90 years (p=0.008), Killip > or =III on admission (p=0.015), and time from symptoms to PCI >12 h (p=0.04) as independent predictors of mortality at long-term follow-up.


CONCLUSIONS
The low incidence of procedural complications, together with good long term survival, suggest that primary PCI in STEMI patients > or =85 years is safe and efficacious, with a low rate of PCI failure in the presence of a low Killip class on admission, whereas primary PCI is unable to affect the poor prognosis for very old patients with cardiogenic shock.
Valente
Serafina
S
Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. seravalente@hotmail.com
Lazzeri
Chiara
C
Salvadori
Claudia
C
Chiostri
Marco
M
Giglioli
Cristina
C
Poli
Serena
S
Gensini
Gian Franco
GF
D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D012449:Safety; D012770:Shock, Cardiogenic; D013997:Time Factors; D016896:Treatment Outcome