Open AccessOutcomes and Predictors of Mortality Among Octogenarians and Older With ST ‐Segment Elevation Myocardial Infarction Treated With Primary Coronary Angioplasty
Author(s) -
Caretta Giorgio,
Passamonti Enrico,
Pedroni Paolo Nicola,
Fadin Bianca Maria,
Galeazzi Gian Luca,
Pirelli Salvatore
Publication year - 2014
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.22313
Subject(s) - medicine , killip class , cardiology , myocardial infarction , timi , ejection fraction , hazard ratio , percutaneous coronary intervention , thrombolysis , heart failure , coronary artery disease , angioplasty , confidence interval
Background Elderly patients are at high risk of mortality when they present with ST ‐elevation myocardial infarction ( STEMI ). However, few data exist about prognostic factors in this sub‐group when treated with primary percutaneous coronary intervention ( pPCI ). Hypothesis To assess outcome and predictors of mortality among patients aged >80 years treated with pPCI. Methods We evaluated 139 consecutive patients (age 85.1 ± 3.9 years, 43.2% males) who underwent pPCI for STEMI . Results Male patients were younger and were more likely to have a history of coronary artery disease. Overall 30‐day and 1‐year mortality rates were 20.9% and 28.1%, respectively. Thrombolysis in Myocardial Infarction ( TIMI ) flow 3 was achieved in 82% of patients. There was a pPCI success rate in male patients. At univariable analysis, older age, diabetes mellitus, Killip class > III , left ventricular ejection fraction ( LVEF ) <40%, no use of stent, failure of pPCI , systolic blood pressure ( SBP ) <100 mm Hg, and infarct‐related artery (left anterior descending vs others) were associated with higher 1‐year mortality. Multivariate analysis identified LVEF <40% (hazard ratio: [ HR ] = 3.70; 95% confidence interval [ CI ]: 1.30‐7.87; P = 0.0001), age (1‐year step, HR : 1.13; 95% CI : 1.04‐1.23; P = 0.007), failure of pPCI ( HR : 2.93; 95% CI : 1.44‐5.98; P = 0.0001), Killip class ≥ III ( HR : 2.29; 95% CI : 1.03‐5.4; P = 0.04) and SBP <100 mm Hg ( HR : 2.64; 95% CI : 1.22‐5.19; P = 0.01) to be independently associated with increased 1‐year mortality. Conclusions Our data show that elderly patients with STEMI have a high risk of mortality, which is particularly high in the first 30 days. Older age, LVEF <40% at admission, hemodynamic instability (higher Killip class or low SBP ), and postinterventional TIMI flow <3 were independent predictors of mortality in our population.