BACKGROUND: Data on contemporary real-world outcomes of interventional revascularization in patients > or = 75 y of age with ST elevation infarction (STEMI) are limited. METHODS: We analyzed all 504 consecutive patients who underwent angiography for acute STEMI between 1999 and 2005 at our center, and followed them up over one year. Outcomes in patients > or = 75 y of age were compared with younger patients. RESULTS: Patients > or = 75 y of age (n = 115) were majority females (55% versus 21%, p < 0.001), more cases of diabetes (42% versus 27%, p = 0.004), hypertension (78% versus 65%, p = 0.03) and a history of coronary events (25% versus 15%, p = 0.002). Younger patients were more often smokers (63% versus 30%, p < 0.001). After coronary angiography patients > or = 75 y of age underwent less frequent intervention (PCI; 84% versus 93%, p = 0.01). However, if PCI was performed, technical success rates were similar to younger patients (84% versus 86%). The 30-d mortality was 13% versus 6.4% (p = 0.03), but after successful PCI, the 30-d mortality rate was not significantly higher in old patients (7.4% versus 3.9%, p = 0.23). Bleeding complications were very low in both age groups if the radial access route was chosen. Multivariate predictors of 30-d mortality were cardiogenic shock/survived cardiac arrest, ejection fraction < 30%, conservative treatment or unsuccessful PCI (OR 3.01), renal insufficiency, diabetes, and age. One-y mortality was higher in the elderly (24.3% versus 9.9%, p < 0.001). Among 30-d-survivors, only multivessel disease and age were multivariate predictors of 1-y mortality. CONCLUSION: Patients > or = 75 y of age benefit from PCI in STEMI, and failed or unattempted PCI worsens prognosis in the old as well as in younger patients.
BACKGROUND: Data on contemporary real-world outcomes of interventional revascularization in patients > or = 75 y of age with ST elevation infarction (STEMI) are limited. METHODS: We analyzed all 504 consecutive patients who underwent angiography for acute STEMI between 1999 and 2005 at our center, and followed them up over one year. Outcomes in patients > or = 75 y of age were compared with younger patients. RESULTS:Patients > or = 75 y of age (n = 115) were majority females (55% versus 21%, p < 0.001), more cases of diabetes (42% versus 27%, p = 0.004), hypertension (78% versus 65%, p = 0.03) and a history of coronary events (25% versus 15%, p = 0.002). Younger patients were more often smokers (63% versus 30%, p < 0.001). After coronary angiography patients > or = 75 y of age underwent less frequent intervention (PCI; 84% versus 93%, p = 0.01). However, if PCI was performed, technical success rates were similar to younger patients (84% versus 86%). The 30-d mortality was 13% versus 6.4% (p = 0.03), but after successful PCI, the 30-d mortality rate was not significantly higher in old patients (7.4% versus 3.9%, p = 0.23). Bleeding complications were very low in both age groups if the radial access route was chosen. Multivariate predictors of 30-d mortality were cardiogenic shock/survived cardiac arrest, ejection fraction < 30%, conservative treatment or unsuccessful PCI (OR 3.01), renal insufficiency, diabetes, and age. One-y mortality was higher in the elderly (24.3% versus 9.9%, p < 0.001). Among 30-d-survivors, only multivessel disease and age were multivariate predictors of 1-y mortality. CONCLUSION:Patients > or = 75 y of age benefit from PCI in STEMI, and failed or unattempted PCI worsens prognosis in the old as well as in younger patients.
Authors: Gregg W Stone; Cindy L Grines; David A Cox; Eulogio Garcia; James E Tcheng; John J Griffin; Giulio Guagliumi; Thomas Stuckey; Mark Turco; John D Carroll; Barry D Rutherford; Alexandra J Lansky Journal: N Engl J Med Date: 2002-03-28 Impact factor: 91.245
Authors: Bruce R Brodie; Thomas D Stuckey; Denise B Muncy; Charles J Hansen; Thomas C Wall; Mark Pulsipher; Navin Gupta Journal: Am Heart J Date: 2003-04 Impact factor: 4.749
Authors: D Antoniucci; R Valenti; G M Santoro; L Bolognese; G Moschi; M Trapani; E Taddeucci; P F Fazzini Journal: Am Heart J Date: 1999-10 Impact factor: 4.749
Authors: C L Grines; D A Cox; G W Stone; E Garcia; L A Mattos; A Giambartolomei; B R Brodie; O Madonna; M Eijgelshoven; A J Lansky; W W O'Neill; M C Morice Journal: N Engl J Med Date: 1999-12-23 Impact factor: 91.245
Authors: V S DeGeare; G W Stone; L Grines; B R Brodie; D A Cox; E Garcia; T P Wharton; J A Boura; W W O'Neill; C L Grines Journal: Am J Cardiol Date: 2000-07-01 Impact factor: 2.778