BACKGROUND: Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort. METHODS: Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years. RESULTS: Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75-8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001). CONCLUSION: Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.
BACKGROUND: Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort. METHODS: Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years. RESULTS: Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75-8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001). CONCLUSION: Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.
Authors: Olga Bondarenko; Aernout M Beek; Mark B M Hofman; Harald P Kühl; Jos W R Twisk; Willem G van Dockum; Cees A Visser; Albert C van Rossum Journal: J Cardiovasc Magn Reson Date: 2005 Impact factor: 5.364
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Authors: Jennifer Logue; Heather M Murray; Paul Welsh; James Shepherd; Chris Packard; Peter Macfarlane; Stuart Cobbe; Ian Ford; Naveed Sattar Journal: Heart Date: 2011-02-14 Impact factor: 5.994
Authors: K C Wu; R J Kim; D A Bluemke; C E Rochitte; E A Zerhouni; L C Becker; J A Lima Journal: J Am Coll Cardiol Date: 1998-11-15 Impact factor: 24.094
Authors: Etienne Puymirat; Tabassome Simon; Philippe Gabriel Steg; François Schiele; Pascal Guéret; Didier Blanchard; Khalife Khalife; Patrick Goldstein; Simon Cattan; Laurent Vaur; Jean-Pierre Cambou; Jean Ferrières; Nicolas Danchin Journal: JAMA Date: 2012-09-12 Impact factor: 56.272
Authors: Jakub J Regieli; J Wouter Jukema; Hendrik M Nathoe; Aeilko H Zwinderman; Sunanto Ng; Diederick E Grobbee; Yolanda van der Graaf; Pieter A Doevendans Journal: Int J Cardiol Date: 2008-02-01 Impact factor: 4.164