title: Mid-term mortality of very elderly patients with acute myocardial infarction with or without coronary intervention.
abstract: BACKGROUND
  The risk benefit of percutaneous coronary intervention (PCI) in very elderly patients with acute myocardial infarction (AMI) is currently unclear. Here, we aim to identify the characteristics of these patients and clarify their mid-term mortality rate with or without PCI.
  
  
  RESULTS
  77 patients (> or =80 years) were chosen from 506 patients with AMI, and treated with (n=32) or without (n=45) PCI. The mean age and time from onset to admission increased in patients having undergone no PCI. The reasons for PCI refusal were patient/family preference (40%), renal dysfunction (17.8%), or cognitive impairment (13.3%). Patients treated with PCI had lower mid-term mortality than those without PCI (34.4% vs 62.2%; p=0.02), while patients taking beta-blockers displayed a significantly lower mortality rate than those without (18.2% vs 63.6%; p=0.0003). Cognitively impaired patients had a higher mortality rate compared with cognitively normal patients (80.0% vs 46.3%; p=0.005). Multivariate analysis indicated that systolic blood pressure on admission, PCI, and beta-blocker therapy independently decreased mid-term mortality in these patients.
  
  
  CONCLUSIONS
  PCI and beta-blocker therapy displayed significantly beneficial effects on mid-term mortality in very elderly AMI patients. Elderly-specific trials concerning coexisting disorders are needed to further examine the treatment-related benefits.
authors.affiliation: Department of Cardiology, National Hospital Organization, Kagoshima Medical Center, 8-1 Shiroyama-cho, Kagoshima 892-0853, Japan. k-kashima@kagomc2.hosp.go.jp
authors.forename: Katsuro
authors.initials: K
authors.lastname: Kashima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ikeda
authors.forename: Hideki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Erika
authors.initials: E
authors.lastname: Yamashita
authors.forename: Shinya
authors.initials: S
authors.lastname: Nagayoshi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoshishige
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Tanoue
authors.forename: Shinjirou
authors.initials: S
authors.lastname: Nagano
authors.forename: Norihito
authors.initials: N
authors.lastname: Nuruki
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshinaga
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sonoda
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001794:Blood Pressure; D002423:Cause of Death; D003072:Cognition Disorders / Q000150:complications; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016312:Treatment Refusal
chemical_list: D000319:Adrenergic beta-Antagonists