Contemporary Clinical Outcomes of Primary Percutaneous Coronary Intervention in Elderly versus Younger Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction

Hafiz, Abdul Moiz; Jan, Muhammad Fuad; Mori, Naoyo; Gupta, Anjan; Bajwa, Tanvir; Allaqaband, Suhail

doi:10.1111/j.1540-8183.2011.00634.x

Cited by 23 publications

(22 citation statements)

References 32 publications

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“…involving only patients undergoing catheterization within 24 hours from admission, the in-hospital mortality rate was substantially higher in both age groups comparing to our cohort (11.7% in the patients ≥ 70 years and 5.0% in patients < 70 years). Since age is a factor that cannot be changed, we have to focus on improvement of other modalities that can be influenced, such as shortening of the times between symptom onset and primary PCI [15]. Our findings strongly support the use of PCI in all patients (HR 0.60, p = 0.008 in younger patients and HR 0.46; p < 0.001 in older patients), which was also demonstrated by Nicolau et al [16] in the ≥ 70 years population in adjusted models (HR 0.64, p = 0.001 older patients vs. HR 0.74, p = 0.073 younger patients).…”

Section: Discussionmentioning

confidence: 99%

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

Kala

Kaňovský

Rokyta

et al. 2012

BMC Cardiovasc Disord

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kala

Kaňovský

Rokyta

et al. 2012

BMC Cardiovasc Disord

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“…There are also relatively few recent observational studies that have looked at the effectiveness and safety of PPCI in elderly patients, with one of them comparing the results with patients who received fibrinolysis in two hospitals prior to the introduction of PPCI in their region. [6][7][8][9] In the recently published study from North American 'Get with the Guideline-Coronary Artery Disease' registry, which included patients of at least 80 years admitted with STEMI from 438 medical centres, 43% underwent PPCI, 5% received fibrinolytic therapy, whereas 52% did not receive any re-perfusion treatment. 10 In England and Wales, around 18% of patients admitted with STEMI in 2010/2011 were of at least 80 years of age.…”

Section: Introductionmentioning

confidence: 99%

Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting with ST elevation myocardial infarction?

Showkathali

Boston-Griffiths²,

Parker³

et al. 2014

Journal of Cardiovascular Medicine

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“…PCI is being increasingly performed in elderly patients [8,9,10,11]. Reported peri-procedural mortality is 6.9-7.6% in elective procedures [9,12,13,14], but can be as high as 15.5-17.2% in octogenarians with acute ST elevated myocardial infarcts [15,16]. Patients' subjective perception of their HRQOL is equally as important as objective end-points such as mortality in considering PCI [4,17,18].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review on the Quality of Life Benefits after Percutaneous Coronary Intervention in the Elderly

Shan

Saxena²,

McMahon³

2014

Cardiology

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Aims: Percutaneous coronary intervention (PCI) is being increasingly performed on elderly patients with acceptable peri-procedural outcomes and long-term survival. We aim to systematically review the health-related quality of life (HRQOL) following PCI in the elderly which is an important measure of procedural success. Methods: A systematic review of clinical studies before September 2012 was performed to identify HRQOL in the elderly after PCI. Strict inclusion and exclusion criteria were applied. Quality appraisal of each study was also performed using pre-defined criteria. HRQOL results were synthesised through a narrative review with full tabulation of results of all included studies. Results: Elderly patients have significant improvements in cardiovascular well-being. Early HRQOL appears improved from baseline, but recovery in physical health may be slower than in younger patients. HRQOL is comparable to an age-matched general population and younger patients undergoing PCI. Conservative management is not able to offer the same HRQOL benefits. Coronary artery bypass graft surgery may be superior to PCI in the very elderly. Significant heterogeneity and bias exists. Lack of appropriate data precluded meta-analysis. Conclusion: HRQOL after PCI in the elderly can improve for at least 1 year across a broad range of health domains, and is comparable to an age-matched general population and younger patients undergoing PCI. Given a limited number of articles and patients included, more prospective studies are needed to better identify the benefits for elderly patients.

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Contemporary Clinical Outcomes of Primary Percutaneous Coronary Intervention in Elderly versus Younger Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction

Cited by 23 publications

References 32 publications

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

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

Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting with ST elevation myocardial infarction?

A Systematic Review on the Quality of Life Benefits after Percutaneous Coronary Intervention in the Elderly

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