title: Successful primary coronary angioplasty improves early and long-term outcomes in ST segment elevation acute coronary syndromes in patients above 80 years of age.
abstract: BACKGROUND
  ST segment elevation myocardial infarction (STEMI) in patients above 80 years of age continues to be a therapeutic challenge. Patients in this age group are rarely included in randomised clinical trials.
  
  
  OBJECTIVE
  Comparison of the effectiveness and safety of STEMI management in octogenarians in hospitals with a 24-hour percutaneous coronary intervention (PCI) capability and hospitals without PCI access.
  
  
  METHODS
  A retrospective analysis of medical records of 50 octogenarians who were treated with PCI (group 1) in one center and 50 patients treated noninvasively in the other 3 hospitals (group 2). We evaluated mortality and major adverse cardiac events after 10 days, 30 days and 1 year.
  
  
  RESULTS
  There were no significant differences in the demographic characteristics of the study groups. The duration of coronary pain was similar in both groups: 318 min in group 1 vs 383 min in group 2 (NS). Mortality in group 2 was significantly higher than in group 1: 40% vs 14%, respectively, after 10 days (p = 0.0034); 48 vs 18% after 30 days (p = 0.0014); and 54% vs 24% after 1 year (p = 0.0021). Thrombolytic treatment was used in only 40% of the patients in group 2. In group 2, acute heart failure (HF) (Killip class III and IV) was diagnosed more frequently than in group 1 (28% vs 12%, p = 0.034). In patients with Killip class I/II HF, mortality in patients in group 2 and group 1 was 22% vs 9%, at 10 days; 31% vs 14% at 30 days; and 39% vs 20% at 1 year. In patients with Killip class III/IV HF, mortality was 86% vs 50%, at 10 days; 93% vs 50% at 30 days; and 93% vs 50% at 1 year, respectively (all differences NS). In multivariate analysis adjusted for the differences between groups, HF (a negative effect) and a successful PCI (a positive effect) were independent predictors of 1-year survival.
  
  
  CONCLUSIONS
  Successful primary PCI in STEMI patients above 80 years of age resulted in a reduction of early and long-term mortality compared to the medically treated patients. The benefits of PCI treatment accrued during the follow-up. In patients treated in the tertiary reference centre in whom PCI was not successful or was not deemed feasible, prognosis was similar to that in the medically treated patients. The latter patients rarely received thrombolytic treatment.
authors.affiliation: Department of Ischaemic Heart Disease, Institute of Cardiology, Warsaw, Poland. hannarymuza@wp.pl
authors.forename: Hanna
authors.initials: H
authors.lastname: Rymuza
authors.forename: Ilona
authors.initials: I
authors.lastname: Kowalik
authors.forename: Andrzej
authors.initials: A
authors.lastname: Drzewiecki
authors.forename: Wojciech
authors.initials: W
authors.lastname: Krzyżanowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Olszewski
authors.forename: Rafał
authors.initials: R
authors.lastname: Dąbrowski
authors.forename: Barbara
authors.initials: B
authors.lastname: Jędrzejczyk
authors.forename: Jacek
authors.initials: J
authors.lastname: Woźniak
authors.forename: Cezary
authors.initials: C
authors.lastname: Sosnowski
authors.forename: Hanna
authors.initials: H
authors.lastname: Szwed
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome