The role of invasive therapies in elderly patients with acute myocardial infarction.
BACKGROUND
In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies--IT), especially in the context of long-term outcomes after hospital discharge.


METHODS
We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were >70 years old (elderly group--EG), and 1040 were <70 years of age (younger group--YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy--CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models.


RESULTS
By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG.


CONCLUSIONS
Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.
Nicolau
José C
JC
Acute Coronary Disease Unit, Faculdade de Medicina, Heart Institute, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. corjnicolau@incor.usp.br
Lemos
Pedro A
PA
Wajngarten
Maurício
M
Giraldez
Roberto R
RR
Serrano
Carlos V
CV
Martinez
Eulógio E
EE
Baracioli
Luciano M
LM
Kalil
Roberto
R
Jatene
Fábio B
FB
Dallan
Luis A
LA
Puig
Luis B
LB
Stolf
Noedir A
NA
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome