title: Outcomes and predictors of mortality among octogenarians and older with ST-segment elevation myocardial infarction treated with primary coronary angioplasty.
abstract: BACKGROUND
  Elderly patients are at high risk of mortality when they present with ST-elevation myocardial infarction (STEMI). However, few data exist about prognostic factors in this sub-group when treated with primary percutaneous coronary intervention (pPCI).
  
  
  OBJECTIVE
  To assess outcome and predictors of mortality among patients aged >80 years treated with pPCI.
  
  
  METHODS
  We evaluated 139 consecutive patients (age 85.1 ± 3.9 years, 43.2% males) who underwent pPCI for STEMI.
  
  
  RESULTS
  Male patients were younger and were more likely to have a history of coronary artery disease. Overall 30-day and 1-year mortality rates were 20.9% and 28.1%, respectively. Thrombolysis in Myocardial Infarction (TIMI) flow 3 was achieved in 82% of patients. There was a pPCI success rate in male patients. At univariable analysis, older age, diabetes mellitus, Killip class >III, left ventricular ejection fraction (LVEF) <40%, no use of stent, failure of pPCI, systolic blood pressure (SBP) <100 mm Hg, and infarct-related artery (left anterior descending vs others) were associated with higher 1-year mortality. Multivariate analysis identified LVEF <40% (hazard ratio: [HR] = 3.70; 95% confidence interval [CI]: 1.30-7.87; P = 0.0001), age (1-year step, HR: 1.13; 95% CI: 1.04-1.23; P = 0.007), failure of pPCI (HR: 2.93; 95% CI: 1.44-5.98; P = 0.0001), Killip class ≥III (HR: 2.29; 95% CI: 1.03-5.4; P = 0.04) and SBP <100 mm Hg (HR: 2.64; 95% CI: 1.22-5.19; P = 0.01) to be independently associated with increased 1-year mortality.
  
  
  CONCLUSIONS
  Our data show that elderly patients with STEMI have a high risk of mortality, which is particularly high in the first 30 days. Older age, LVEF <40% at admission, hemodynamic instability (higher Killip class or low SBP), and postinterventional TIMI flow <3 were independent predictors of mortality in our population.
authors.affiliation: Department of Cardiology, A.O. "Istituti Ospitalieri" di Cremona, Cremona, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Caretta
authors.forename: Enrico
authors.initials: E
authors.lastname: Passamonti
authors.forename: Paolo Nicola
authors.initials: PN
authors.lastname: Pedroni
authors.forename: Bianca Maria
authors.initials: BM
authors.lastname: Fadin
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Galeazzi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pirelli
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents
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