Age-Related Increase in Mortality among Patients with First Myocardial Infarctions Treated with Thrombolysis

Maggioni, Aldo P.; Maseri, Attilio; Fresco, Claudio; Franzosi, M.G.; Mauri, Francesco; Santoro, Eugenio; Tognoni, Gianni

doi:10.1056/nejm199311113292002

Cited by 340 publications

(86 citation statements)

References 16 publications

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“…Aging is associated with a progressive decline in physiological reserves that reduces the capacity for work (Chantler et al, 2006;Goldspink, 2005) and increases the susceptibility to injury (Abete et al, 1996;Juhaszova et al, 2005;Lesnefsky et al, 1994;Maggioni et al, 1993). A case in point is the myocardium, an aerobic tissue with high energy demands dependent on mitochondrial oxidative phosphorylation (OxPhos) where aging precipitates organ failure during stress.…”

Section: Introductionmentioning

confidence: 99%

Aging-induced alterations in gene transcripts and functional activity of mitochondrial oxidative phosphorylation complexes in the heart

Preston¹,

Oberlin²,

Holmuhamedov³

et al. 2008

Mechanisms of Ageing and Development

126

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Aging is associated with progressive decline in energetic reserves compromising cardiac performance and tolerance to injury. Although deviations in mitochondrial functions have been documented in senescent heart, the molecular bases for the decline in energy metabolism are only partially understood. Here, high-throughput transcription profiles of genes coding for mitochondrial proteins in ventricles from adult (6-months) and aged (24-months) rats were compared using microarrays. Out of 614 genes encoding for mitochondrial proteins, 94 were differentially expressed with 95% downregulated in the aged. The majority of changes affected genes coding for proteins involved in oxidative phosphorylation (39), substrate metabolism (14) and tricarboxylic acid cycle (6). Compared to adult, gene expression changes in aged hearts translated into a reduced mitochondrial functional capacity, with decreased NADH-dehydrogenase and F0F1-ATPase complex activities and capacity for oxygen-utilization and ATP synthesis. Expression of genes coding for transcription co-activator factors involved in the regulation of mitochondrial metabolism and biogenesis were downregulated in aged ventricles without reduction in mitochondrial density. Thus, aging induces a selective decline in activities of oxidative phosphorylation complexes I and V within a broader transcriptional downregulation of mitochondrial genes, providing a substrate for reduced energetic efficiency associated with senescence.

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Section: Introductionmentioning

confidence: 99%

Aging-induced alterations in gene transcripts and functional activity of mitochondrial oxidative phosphorylation complexes in the heart

Preston¹,

Oberlin²,

Holmuhamedov³

et al. 2008

Mechanisms of Ageing and Development

126

View full text Add to dashboard Cite

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“…Other previous studies reported that mortality reaches ≥30% in octogenarian patients with AMI. 2,9,12) In this study, in-hospital mortality of the octogenarians with AMI was 19.9%. This suggests that emergent coronary angiography and subsequent intervention may be superior to thrombolysis and routine therapy with antiplatelet agents and heparin alone.…”

Section: Discussionmentioning

confidence: 54%

“…Previously reported reasons for increased mortality among elderly patients were multifactorial, including a high prevalence of comorbidity, 8,9) more diffuse multivessel disease, 4,8,10) delayed presentation, 11) greater risk of cardiac rupture, 12) insufficient use of beta-blocker 13) and aspirin, 14) and less aggressive treatment. 15) In this study, in-hospital mortality in the octogenarians with ACS was about three times higher than in the younger patients in spite of a similar rate of successful intervention.…”

Section: Discussionmentioning

confidence: 99%

In-hospital Outcome in Octogenarians with Acute Coronary Syndrome Undergoing Emergent Coronary Angiography.

Shimizu

Ino

et al. 2003

Jpn Heart J

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SUMMARYVery elderly patients have higher mortality rates than younger patients after acute coronary syndrome (ACS). However, the mechanism by which increasing age contributes to such mortality remains unclear. In addition, the efficacy and safety of invasive coronary procedures for octogenarians with ACS have not been well established.We compared the clinical characteristics and in-hospital outcome of 193 octogenarians (mean age, 83 years) with those of 1,462 younger patients (mean age, 64 years) with ACS who underwent emergent coronary angiography. Octogenarians included a greater number of females, had higher rates of cerebrovascular disease and multivessel disease, a higher Killip class, a higher Forrester class, and lower rates of smoking, diabetes, and hypercholesterolemia than the younger subjects. Interventions, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), were performed less frequently in octogenarians than in younger patients (88.0% versus 90.8%). The procedural success rate in octogenarians did not differ from that in younger patients. However, the in-hospital mortality rate for the octogenarians was about three times higher than for the younger patients (19.2% versus 6.9%). Multivariate analysis revealed that the predictors of in-hospital mortality in the octogenarians were a higher Killip class and a higher Forrester class.Octogenarians with ACS had fewer coronary risk factors and a similar success rate for the intervention, but had more greatly impaired hemodynamics and higher in-hospital mortality than the younger patients. Therefore, impaired myocardial reserve may contribute to a large portion of in-hospital deaths in octogenarians with ACS. (Jpn Heart J 2003; 44: 11-20)

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“…In our study, the risk stratification was performed 24 hours after the successful d-PCI and our results demonstrated that, for low risk patients, only very few combined untoward events occurred within 30 days after d-PCI. Previous studies [18][19][20][21] have demonstrated that serious complications, including death, usually occur within 48 hours after AMI. Therefore, it would be more appropriate to perform risk stratification at least 24 hours after d-PCI for patients with AMI in order to safely discharge patients earlier.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility and Safety of Early Discharge for Low Risk Patients with Acute Myocardial Infarction after Successful Direct Percutaneous Coronary Intervention.

Yip

Chang

et al. 2003

Jpn Heart J

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SUMMARYThere is a lack of consensus among cardiologists regarding the length of time patients should be hospitalized after an uncomplicated acute myocardial infarction (AMI) and successful direct percutaneous coronary intervention (d-PCI). The purpose of this study was to evaluate the feasibility and safety of early discharge (discharge <4 days after the procedure) for low risk patients with AMI who underwent successful d-PCI.From

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Age-Related Increase in Mortality among Patients with First Myocardial Infarctions Treated with Thrombolysis

Abstract: In patients with first myocardial infarctions who received thrombolytic therapy, age was a powerful independent predictor of both in-hospital and post-discharge mortality rates. The exponential, age-related increase in the mortality rate did not appear to be explained by larger infarcts.

Cited by 340 publications

References 16 publications

Aging-induced alterations in gene transcripts and functional activity of mitochondrial oxidative phosphorylation complexes in the heart

Aging-induced alterations in gene transcripts and functional activity of mitochondrial oxidative phosphorylation complexes in the heart

In-hospital Outcome in Octogenarians with Acute Coronary Syndrome Undergoing Emergent Coronary Angiography.

The Feasibility and Safety of Early Discharge for Low Risk Patients with Acute Myocardial Infarction after Successful Direct Percutaneous Coronary Intervention.

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