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Platelet count predicts cardiovascular mortality in very elderly patients with myocardial infarction
Author(s) -
Goliasch Georg,
Forster Stefan,
ElHamid Feras,
Sulzgruber Patrick,
Meyer Nicolai,
Siostrzonek Peter,
Maurer Gerald,
Niessner Alexander
Publication year - 2013
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12049
Subject(s) - medicine , myocardial infarction , hazard ratio , cohort , risk factor , platelet , proportional hazards model , cardiology , cohort study , confidence interval
Background The prognosis of elderly patients with acute myocardial infarction ( AMI ) is poor, and information on specific risk factors remains scarce. The aim of our study was to assess the influence of platelet count on cardiovascular mortality in very elderly patients with acute myocardial infarction (≥ 85 years of age). Methods We identified 208 elderly AMI patients and compared the platelet count with 208 matched young AMI patients (≤ 65 years) and 208 matched intermediate age AMI patients (66–84 years) who derived from the same cohort. Results During a median follow‐up of 4·7 years, 25% of patients ( n = 156) died of cardiovascular causes (97 very elderly, 46 intermediate age and 13 young age patients). We detected a mean platelet count of 227G/l ( SD ± 83) in very elderly AMI patients, of 236G/l ( SD ± 78) in the intermediate AMI group and of 254G/l ( SD ± 79) in 208 young AMI patients ( anova P = 0·002). We revealed a significant interaction between age and platelet count with regard to cardiovascular mortality (p for interaction = 0·014). Platelet count displayed a significant risk transformation from an independent risk factor for cardiovascular mortality in very elderly AMI patients (adj. hazard ratio ( HR ) per 1‐ SD increase 1·25;95% CI 1·02–1·54; P = 0·028), via displaying no association with mortality in the intermediate age group ( P = 0·10), to a strong inverse association in young patients (adj. HR 0·36;95% CI 0·18–0·68; P = 0·002). Conclusion Our study demonstrates an independent association between elevated platelet count and long‐term cardiovascular mortality in the growing and vulnerable group of very elderly AMI patients. Nevertheless, the pathophysiologic mechanisms underlying this age‐dependent effect have to be further clarified.