Old Age and Outcome After Primary Angioplasty for Acute Myocardial Infarction

Boer, Menko‐Jan de; Ottervanger, Jan Paul; Suryapranata, Harry; Hoorntje, Jan C.A.; Dambrink, Jan‐Henk E.; Gosselink, A T Marcel; Hof, and Arnoud W.J. van't; Zijlstra, Felix

doi:10.1111/j.1532-5415.2010.02821.x

Cited by 26 publications

(36 citation statements)

References 16 publications

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“…The significant decline in the rate of participants achieving postprocedural TIMI grade 3 flow with advancing age was consistent with previous studies, although the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications trial failed to show any significant relationship between age and procedural failure . More complex lesion morphology, persisting vasospasm, diffuse coronary artery sclerosis, tortuosity of vessels, and a higher prevalence of calcified coronary lesions in older adults might be an explanation for procedural failure . Older age is also independently associated with no reflow after PCI in individuals with STEMI, a phenomenon predictive of in‐hospital mortality …”

Section: Discussionmentioning

confidence: 99%

Age‐Related Differences in Reperfusion Therapy and Outcomes for ST‐Segment Elevation Myocardial Infarction

Turk

Fourny

Yayehd

et al. 2018

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

Age‐Related Differences in Reperfusion Therapy and Outcomes for ST‐Segment Elevation Myocardial Infarction

Turk

Fourny

Yayehd

et al. 2018

J American Geriatrics Society

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“…First, people aged ≥85 years are the fastest growing segment of the general population, and data on disability in this population are limited (Vaupel 2010). This age group is often excluded from clinical trials and preventive interventions, and is sometimes undertreated (Habicht et al 2008; de Boer et al 2010; Fracheboud et al 2006). Therefore, the results of this study in this specific population provide valuable information to help develop preventive strategies directed towards disability in this age group.…”

Section: Discussionmentioning

confidence: 99%

Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Houwelingen

Cameron

Gussekloo

et al. 2013

AGE

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Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0 %) were disabled in IADL only, and 155 participants (26.0 %) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6 %) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95 % CI, 0.58–0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95 % CI, 0.37–1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95 % CI, 0.28–0.87)]. Participants with depressive symptoms [HR, 1.46 (95 % CI, 1.12–1.91)], >1 chronic disease [HR, 1.60 (95 % CI, 1.27–2.01)], and with cognitive impairment [HR, 1.60 (95 % CI, 1.20–2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration.

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“…Most studies have reported that older age is associated with decreased procedural success after PCI or increased in-hospital complications [10][11][12][13][14], but data on this topic are still controversial. In a retrospective analysis, de Boer et al [27] document that PCI in octogenarians has a high technical and procedural success rate even if older age is independently associated with greater mortality after PCI for AMI. In 88 very elderly (C85 years) STEMI patients [16], we observed that primary PCI was safe and effective, given the low incidence of periprocedural complications and of PCI failure.…”

Section: Discussionmentioning

confidence: 98%

Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience

et al. 2010

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Elderly patients are under-represented in trials assessing strategies of early coronary revascularization in acute myocardial infarction, though they are the fastest growing segment of our population. The aims of the present investigation, performed in 357 elderly (≥75 years) patients with ST elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) consecutively admitted to our Intensive Cardiac Care Unit (ICCU) from 1 January 2006 to 31 December 2009, were as follows: (a) to identify predictors for in-ICCU mortality among clinical, angiographic and metabolic factors and (b) to evaluate whether there are gender-related differences in management, outcome and in the metabolic and inflammatory responses to acute myocardial ischemia. At multivariable backward stepwise logistic regression analysis, the following variables were independent predictors for in-ICCU mortality in the overall population: age (OR 1.15; 95% CI 1.05-1.27; p < 0.003), admission glycemia (OR 2.24; 95% CI 1.41-3.56; p < 0.001), left ventricular ejection fraction (LVEF) (OR 0.92; 95% CI 0.88-0.97; p < 0.001), primary PCI failure (OR 4.70; 95% CI 1.70-12.98; p < 0.003). In elderly STEMI patients submitted to primary PCI, early mortality can be related to age, hemodynamic derangement (as indicated by LVEF), the rate of procedural success, and increased glucose values. No gender-related differences in management were detectable in our series. Our data strongly suggest that, in elderly patients in the acute phase of STEMI, since hyperglycemia is a modifying factor, glucose values deserve a more intensive treatment. Further studies, performed specifically in elderly STEMI patients, should be addressed to identify the glucose cut-off values able to influence the outcome.

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Old Age and Outcome After Primary Angioplasty for Acute Myocardial Infarction

Abstract: In this retrospective analysis, older age was independently associated with greater mortality after PCI for AMI. Patients aged 65 and older had a higher risk of mortality than younger patients, and those aged 75 and older had the highest risk of mortality.

Cited by 26 publications

References 16 publications

Age‐Related Differences in Reperfusion Therapy and Outcomes for ST‐Segment Elevation Myocardial Infarction

Age‐Related Differences in Reperfusion Therapy and Outcomes for ST‐Segment Elevation Myocardial Infarction

Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience

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