Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction.
BACKGROUND
Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI.


METHODS
Single-center, observational, and retrospective cohort study.


METHODS
Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL.


RESULTS
The prevalence of Killip class II-IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II-IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52-17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31-14.3, P=0.017, respectively).


CONCLUSIONS
Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex.
Department of Cardiology, Nagano Matsushiro General Hospital.
Hiroyuki
H
Nakajima
Department of Cardiology, Nagano Red Cross Hospital.
Jiro
J
Yoshioka
Department of Cardiology, Nagano Red Cross Hospital.
Nobuyuki
N
Totsuka
Department of Cardiology, Nagano Red Cross Hospital.
Izumi
I
Miyazawa
Department of Cardiology, Nagano Red Cross Hospital.
Tatsuya
T
Usui
Department of Cardiology, Nagano Red Cross Hospital.
Nobuyuki
N
Urasawa
Department of Cardiology, Nagano Municipal Hospital, Nagano.
Takahiro
T
Kobayashi
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Tomoaki
T
Mochidome
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
Killip classification; activities of daily living; acute myocardial infarction; disability; primary percutaneous coronary intervention