title: The role of invasive therapies in elderly patients with acute myocardial infarction.
abstract: 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.
authors: Acute Coronary Disease Unit, Faculdade de Medicina, Heart Institute, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. corjnicolau@incor.usp.br
authors: José C
authors: JC
authors: Nicolau
authors: Pedro A
authors: PA
authors: Lemos
authors: Maurício
authors: M
authors: Wajngarten
authors: Roberto R
authors: RR
authors: Giraldez
authors: Carlos V
authors: CV
authors: Serrano
authors: Eulógio E
authors: EE
authors: Martinez
authors: Luciano M
authors: LM
authors: Baracioli
authors: Roberto
authors: R
authors: Kalil
authors: Fábio B
authors: FB
authors: Jatene
authors: Luis A
authors: LA
authors: Dallan
authors: Luis B
authors: LB
authors: Puig
authors: Noedir A
authors: NA
authors: Stolf
mesh_terms: 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