Influence of age on long-term outcome after emergent percutaneous coronary intervention for ST-elevation myocardial infarction.
BACKGROUND
Percutaneous coronary intervention (PCI) provides advantages compared to thrombolytic therapy in the treatment of ST-elevation myocardial infarction (STEMI). Elderly patients have increased in-hospital mortality; the predictors of adverse outcomes are not well established, with limited data available regarding late follow up of these patients. We evaluated early and late outcomes of patients undergoing emergent PCI for STEMI to identify the predictors of subsequent late adverse events and, in particular, determine if age alone was a predictor of an adverse outcome.


METHODS
A retrospective review of all patients referred for emergent PCI for STEMI to a single tertiary referral center was performed. All patients undergoing primary PCI for STEMI or rescue PCI for failed thrombolysis between December 2003 and December 2007 were included for assessment.


RESULTS
During the study period, 269 patients underwent primary or rescue PCI for STEMI. Patients > or = 70 years of age were more likely to have established cardiovascular risk factors and documented coronary artery disease. Thrombolysis in myocardial infarction (TIMI) 3 flow predicted a good outcome, whereas recurrent ischemia in hospital, prior aspirin therapy and discharge creatinine predicted a poor outcome; age alone was not an adverse prognostic factor.


CONCLUSIONS
The increased mortality in elderly patients undergoing PCI for STEMI reflects comorbidity and suboptimal procedural outcomes rather than any age effect per se. Future approaches to optimize the management of STEMI in the elderly should include identification of those patients most likely to benefit from an invasive approach.
Cardiovascular Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.
Chin
C
Hiew
Trent
T
Williams
Rachael
R
Hatton
Seshasayee
S
Narasimhan
Simon
S
O'Connor
Fran
F
Baker
Patrick
P
McElduff
John
J
Attia
Nicholas
N
Collins
D017677:Age Distribution; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001241:Aspirin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000401:mortality; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D017052:Hospital Mortality; D006801:Humans; D009017:Morbidity; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D003404:Creatinine; D001241:Aspirin