Roberta Sappa1, Maria Teresa Grillo2, Martino Cinquetti3, Giulio Prati3, Leonardo Spedicato2, Gaetano Nucifora2, Andrea Perkan4, Davide Zanuttini2, Gianfranco Sinagra5, Alessandro Proclemer2. 1. Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy. Electronic address: roberta.sappa@asuiud.sanita.fvg.it. 2. Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy. 3. Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy. 4. Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy. 5. Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy; Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy.
Abstract
BACKGROUND: Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). METHODS AND RESULTS: We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. CONCLUSIONS: PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.
BACKGROUND: Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). METHODS AND RESULTS: We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. CONCLUSIONS: PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.
Authors: Leor Perl; Alfonso Franzé; Fabrizio D'Ascenzo; Noa Golomb; Amos Levi; Hana Vaknin-Assa; Gabriel Greenberg; Abid Assali; Gaetano M De Ferrari; Ran Kornowski Journal: J Clin Med Date: 2021-05-30 Impact factor: 4.241