title: Impact of advanced age on myocardial perfusion, distal embolization, and mortality patients with ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb-IIIa inhibitors.
abstract: Despite mechanical reperfusion, the outcome is still unsatisfactory in elderly patients with ST-segment elevation myocardial infarction (STEMI). The vast majority of studies have been conducted without extensive use of glycoprotein (Gp) IIb-IIIa inhibitors, which have been associated with improved perfusion and survival. Thus the aim of the current study was to evaluate the impact of age on the angiographic and clinical outcome patients with STEMI undergoing primary angioplasty with Gp IIb-IIIa inhibitors. Our population is represented by a total of 1,662 patients undergoing primary angioplasty for STEMI included in 11 randomized trials comparing early versus late administration of Gp IIb-IIIa inhibitors. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty. A total of 231 (13.9 %) patients were older than 75 years. Elderly patients showed a larger prevalence of female gender, hypertension, and diabetes, more advanced Killip class at presentation and longer time to treatment, but a smaller prevalence of smoking. All patients were treated with GP IIb-IIIa inhibitors. Elderly patients showed a significantly impaired postprocedural thrombolysis in myocardial infarction (TIMI) flow (TIMI 0-2: 17.7 vs 10.3 %, P = 0.002) and myocardial perfusion (myocardial blush grade 0-1: 38.3 vs 26.5 %, P = 0.001), and higher prevalence of distal embolization (19.2 vs 9.8 %, P < 0.001), whereas no difference was observed in terms of ST-segment resolution. At follow-up, elderly patients showed a significantly higher mortality (3.2 vs 11.0 %, hazard ratio (HR) (95 % confidence interval (CI)) = 3.78 (2.31-6.16), P < 0.001), which was confirmed after adjustment for baseline confounding factors (HR (95 % CI) = 5.01 (2.63-9.55), P < 0.0001). This study showed that among patients with STEMI undergoing primary angioplasty, advanced age is an independent predictor of mortality after primary angioplasty. Higher rates of distal embolization and poor myocardial perfusion, in addition to the worse risk profile, contribute toward explaining the impact of aging on mortality.
authors.affiliation: Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy, giuseppe.deluca@maggioreosp.novara.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van't Hof
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
authors.forename: Hans-Richard
authors.initials: HR
authors.lastname: Arntz
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.forename: Simona
authors.initials: S
authors.lastname: Zorman
authors.forename: Gioel Gabrio
authors.initials: GG
authors.lastname: Secco
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: H Mesquita
authors.initials: HM
authors.lastname: Gabriel
authors.forename: Ayse
authors.initials: A
authors.lastname: Emre
authors.forename: Donald
authors.initials: D
authors.lastname: Cutlip
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Maryann
authors.initials: M
authors.lastname: Gyongyosi
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex