Age – related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era

Abstract

BackgroundOlder age, as a factor we cannot affect, is consistently one of the main negative prognostic values in patients with acute myocardial infarction. One of the most powerful factors that improves outcomes in patients with acute coronary syndromes is the revascularization preferably performed by percutaneous coronary intervention. No data is currently available for the role of age in large groups of consecutive patients with PCI as the nearly sole method of revascularization in AMI patients. The aim of this study was to analyze age-related differences in treatment strategies, results of PCI procedures and both in-hospital and long-term outcomes of consecutive patients with acute myocardial infarction.MethodsRetrospective multicenter analysis of 3814 consecutive acute myocardial infarction patients divided into two groups according to age (1800 patients ≤ 65 years and 2014 patients > 65 years). Significantly more older patients had a history of diabetes mellitus and previous myocardial infarctions.ResultsThe older population had a significantly lower rate of coronary angiographies (1726; 95.9% vs. 1860; 92.4%, p < 0.0001), PCI (1541; 85.6% vs. 1505; 74.7%, p < 0.001), achievement of optimal final TIMI flow 3 (1434; 79.7% vs. 1343; 66.7%, p < 0.001) and higher rate of unsuccessful reperfusion with final TIMI flow 0-1 (46; 2.6% vs. 78; 3.9%, p = 0.022). A total of 217 patients (5.7%) died during hospitalization, significantly more often in the older population (46; 2.6% vs. 171; 8.5%, p < 0.001). The long-term mortality (data for 2847 patients from 2 centers) was higher in the older population as well (5 years survival: 86.1% vs. 59.8%). Though not significantly different and in contrast with PCI, the presence of diabetes mellitus, previous MI, final TIMI flow and LAD, as the infarct-related artery, had relatively lower impact on the older patients. Severe heart failure on admission (Killip III-IV) was associated with the worst prognosis in the whole group of patients, though its significance was higher in the youngers (HR 6.04 vs. 3.14, p = 0.051 for Killip III and 12.24 vs. 5.65, p = 0.030 for Killip IV). We clearly demonstrated age as a strong discriminator for the whole population of AMI patients.ConclusionsIn a consecutive AMI population, the older group (>65 years) was associated with a less pronounced impact of risk factors on long-term outcome. To ascertain the coronary anatomy by coronary angiography and proceed to PCI if suitable regardless of age is crucial in all patients, though the primary success rate of PCI in the older age is lower. Age, when viewed as a risk factor, was a dominant discriminating factor in all patients.

Predictors of long-term (10-year) mortality postmyocardial infarction: Age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project

“…Although the age used for the definition of older or elderly patients varies among trials from 55 to 80 years [8,[20][21][22], standard WHO definition of 65 years, reflecting also the most common retirement age in Europe, was applied for this study. Baseline characteristics of our entire cohort, the characteristics of the older patients specifically, and the higher prevalence of women, NSTEMI, comorbidities, and risk factors in the older population are consistent with other similar cohorts of ''real life'' patients, applying similar age definitions [7,10]. Furthermore, the lower rates of mechanical reperfusion and the significantly increased short-and long-term mortality rates after hospital discharge in the elderly are in agreement with previous reports [7,10].…”

“…However, our results further extend the findings of the latter study due to the longer follow-up period, inclusion of noncardiovascular risk factors and comorbidity, the applicability to all types of AMI and the comparison of the discriminating factors and strength of prediction between the older and the younger population, thus pointing out specific targets of potential intervention for the older group. Kala et al [10] evaluated age-related differences in treatment strategies, results of PCI procedures and long-term mortality (5 years) of patients with all types of AMI. Although, for the most part not statistically significant, the authors report that initial signs of heart failure (Killip II-IV), the presence of DM and previous MI, final thrombolysis in myocardial infarction flow, and the infarct-related artery are significant long-term negative predictors but do not play an important role in the older group (>65 years) as they do in the younger.…”

“…Out of 2773 consecutive patients, 2763 were included, as 10 patients were excluded due to missing age data. The World Heart Organization (WHO) definition was used for creating two groups of patients: younger ( 65 years) and older (>65 years of age) [10].…”

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

“…It has previously been shown that the primary success rate of PCI at older ages is lower than for younger ages (Kala et al, 2012). In line with most former studies, we hypothesized that the statistical effect of PCI was positive, but with diminishing return, in the higher age groups.…”

Prognostic Factors for In-Hospital and Long-Term Survival in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

“…Many studies have shown that PCI surgery can effectively clear the obstruction in the coronary blood ves-sels and restore myocardial blood supply, reducing the incidence of various cardiovascular diseases caused by AMI (Roe et al 2010;Kappetein et al 2013). Recent studies also point out that although the applicability of PCI surgery is not dependent on age, the rate of success of PCI surgery is significantly associated with age (Gharacholou et al 2011;Kala et al 2012). The no-reflow phenomenon is considered to be a risk factor for patients with acute STEMI undergoing primary PCI therapy (Ndrepepa et al 2010).…”