title: Effectiveness and safety of routine primary angioplasty in patients aged > or =85 years with acute myocardial infarction.
abstract: 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.
authors.affiliation: Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. seravalente@hotmail.com
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Claudia
authors.initials: C
authors.lastname: Salvadori
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
authors.forename: Serena
authors.initials: S
authors.lastname: Poli
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: 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