Open AccessOutcomes of contemporary Interventional Therapy of ST Elevation Infarction in Patients Older than 75 Years
Author(s) -
Zimmermann Stefan,
Ruthrof Susanne,
Nowak Kathrin,
Klinghammer Lutz,
Ludwig Josef,
Daniel Werner G.,
Flachskampf Frank A.
Publication year - 2009
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20289
Subject(s) - medicine , conventional pci , cardiogenic shock , myocardial infarction , percutaneous coronary intervention , ejection fraction , diabetes mellitus , cardiology , revascularization , mortality rate , surgery , heart failure , endocrinology
Background Data on contemporary real‐world outcomes of interventional revascularization in patients ≥ 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 ≥ 75 y of age were compared with younger patients. Results Patients ≥ 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 ≥ 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 ≥ 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. Copyright © 2009 Wiley Periodicals, Inc.