A retrospective study of an invasive versus conservative strategy in patients aged ≥80 years with acute ST-segment elevation myocardial infarction

Sui, Yong‐Gang; Teng, Siyong; Qian, Jie; Wu, Yujuan; Dou, Kefei; Tang, Yi‐Da; Qiao, Shubin; Wu, Yongjian

doi:10.1177/0300060519860969

Cited by 6 publications

(7 citation statements)

References 45 publications

(49 reference statements)

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“…Similarly, high Killip class (III & IV) did not show statistically significant data as independent risk factor for in-hospital mortality after P-PCI in elderly population. Those figures were not matching with data for Killip III & IV from previous studies [30,34]. However, it could be argued that the population sample of those studies were smaller and younger than the present study.…”

Section: Discussioncontrasting

confidence: 99%

“…Arterial hypertension and CKD were the only variables demonstrated to be independent risk factors for in-hospital mortality after P-PCI in elderly patients with STEMI. Findings were consistent with previous studies that demonstrated that absence of hypertension and low creatinine levels could provide better clinical outcomes [11,29,30].…”

Section: Discussionsupporting

confidence: 93%

“…Although several studies reported that age is an independent risk factor for in-hospital mortality, [31][32][33] age failed to demonstrate any statistical significances as an independent risk factor for inhospital mortality after P-PCI, and the use of an invasive strategy is still favourable approach for good prognosis in such patients. Matching figures for age were found in prior studies, (12,30,34) where statistical analysis for age was not significant.…”

Section: Discussionmentioning

confidence: 51%

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Assessment of Primary Percutaneous Coronary Intervention Outcomes in Elderly and Very Elderly Patients

Seif

Salama

Elsaeid

et al. 2022

JAMMR

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Background: To date, data regarding safety and efficacy of primary percutaneous coronary intervention (P-PCI) in elderly patients are scarce. We aimed to assess the outcomes of P-PCI in the elderly subgroup, and to evaluate whether the advantages of P-PCI diminish with advanced ages. Methods: This retrospective study included elderly patients who underwent P-PCI for acute STEMI. Patients were sub grouped according to their age into three groups (Group A: aged 75-84, Group B: aged ³85 and control Group C: aged 65-74). The primary endpoint was in-hospital and 30-day all-cause mortality, and secondary endpoints were MACE (death, stroke, MI or re-PCI), stroke, vascular complication, bleeding and transfusion, target vessel re-intervention, contrast induced acute kidney injury (CI-AKI) and gastrointestinal (GI) bleeding. Results: A total of 1111 patients were included with 339 patients in group A, 95 patients in group B and 677 patients in the control group C. In terms of the primary endpoint of our study, no significant difference could be detected between the studied groups. CI-AKI was the only secondary outcome to show a significant difference (P =0.005). Arterial hypertension and a previous history of chronic kidney disease (CKD) were independent predictors of in-hospital mortality, with OR 5.336, 95% CI 1.187 – 23.998 and OR 11.024, 95% CI 2.104 – 57.756, respectively. Additionally, final TIMI flow less than 3 (OR 42.322, 95% CI 5.674 – 315.667) and bleeding that required blood transfusion (OR 87.144, 95% CI 3.086 – 2460.628) showed higher risk of in-hospital MACE. Conclusion: our study revealed that outcomes of P-PCI for STEMI in elderly population (³75) are favourable and comparable to younger patients. Therefore, P-PCI should be offered to every elderly patient presenting with acute STEMI, after considering risk factors for mortality and MACE in this special age group.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 51%

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Assessment of Primary Percutaneous Coronary Intervention Outcomes in Elderly and Very Elderly Patients

Seif

Salama

Elsaeid

et al. 2022

JAMMR

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“…In a considerable research, Sui found that octogenarians have a greater risk of mortality and heart failure during the first months following the AMI. But, after a few months, the prognosis of the elderly patients became similar to that of those aged <80 years [24]. In our study, the analysis of the Kaplan-Meier 1-year mortality and 1-year readmission curves suggest a rather uniform time-distribution of the events in both AMI age-categorized patients.…”

Section: Discussionsupporting

confidence: 59%

Independent predictors of in-hospital and 1-year mortality rates in octogenarians with acute myocardial infarction

Caruntu¹,

Bordejevic²,

Buz³

et al. 2021

Rev. Cardiovasc. Med.

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Older age is known as a negative prognostic parameter in acute myocardial infarction (AMI) patients. In this study, we aimed to explore age-associated differences in treatment protocols, in-hospital and 1-year mortality. This cohort observational study included 277 consecutive AMI patients, separated into 2 groups according to whether their age was ≥80 years or not. We found that group I patients (aged ≥80 years) had a notably lower rate of percutaneous coronary intervention (PCI) performed (P < 0.0001) and a notably higher inhospital death rate (P < 0.003). The multivariate logistic regression analysis found that three variables were independent predictors of in-hospital mortality: age ≥80 years (P < 0.0001), LVEF <40% (P < 0.0001), and Killip class ≥3 (P < 0.0001). The 1-year death rate was again significantly higher in group I patients (P < 0.001) and was independently predicted by the triple-vessel coronary artery disease (P = 0.004) and an LVEF <40% at admission (P = 0.001). The 1-year readmission rate was superior in group I (P < 0.01) and independently predicted by an age ≥80 years (P < 0.001), and an history of congestive heart failure (P < 0.0001) or permanent atrial fibrillation (P < 0.001). We concluded that patients aged ≥80 benefit less often from a PCI and have higher rates of in-hospital mortality, as well as of 1-year readmission and mortality rates.

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“…Ишемическая болезнь сердца (ИБС) занимает лидирующие позиции в структуре заболеваемости и смертности населения развитых стран мира [17]. Благодаря достижениям современной медицины, своевременной доступности методов реваскуляризации миокарда, включающим тромболитическую терапию и инвазивные методы лечения [14,21], уменьшается количество летальных исходов в острый период инфаркта миокарда с подъемом сегмента ST (ИМпST) [4,6,13], и как следствие, наблюдается увеличение выживаемости пациентов после перенесенного ИМпST, включая больных пожилого и старческого возраста [7, 10,12].…”

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Peculiarities of myocardial remodeling in patients of different age groups 6 months after myocardial infarction

Bukatov¹,

Осипова²

2021

Humans and their Health

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Objective. To assess the nature of changes in the types of myocardial remodeling of the left ventricle in patients of middle, elderly and senile age with acute ST-segment elevation myocardial infarction within 6 months after successful revascularization. Materials and methods. The study included 132 patients with a diagnosis of acute ST-segment elevation myocardial infarction, in combination with arterial hypertension who were divided into 3 groups depending on age: middle-aged pa-tients (45- 59) – 48 people, elderly patients (60-74) – 44 people, senile patients (75-89) – 40 people. The type of left ventricular remodeling was assessed by determining the relative wall thickness and mass index of the left ventricular myocardium with doppler echocardiography in the first 12 hours after the onset of anginal syndrome, and after 6 months. All patients underwent percutaneous coronary intervention. Results. It was found that initially with the development of acute myocardial infarction, senile patients more often had eccentric left ventricular hypertrophy (in 25%) than patients of middle (6%) and elderly age (11%). After 6 months, in middle-aged patients, the type of remodeling eccentric hypertrophy increased to 14%, in the elderly – up to 23%, in senile patients – up to 50%. Conclusion. In patients who have undergone acute myocardial infarction against the background of traditional therapy and rehabilitation, there are changes in the types of left ventricular myocardial remodeling: eccentric hypertrophy increases in middle age up to 14%, in the elderly – up to 23%, in senile age – up to 50%.

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A retrospective study of an invasive versus conservative strategy in patients aged ≥80 years with acute ST-segment elevation myocardial infarction

Cited by 6 publications

References 45 publications

Assessment of Primary Percutaneous Coronary Intervention Outcomes in Elderly and Very Elderly Patients

Assessment of Primary Percutaneous Coronary Intervention Outcomes in Elderly and Very Elderly Patients

Independent predictors of in-hospital and 1-year mortality rates in octogenarians with acute myocardial infarction

Peculiarities of myocardial remodeling in patients of different age groups 6 months after myocardial infarction

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