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

BMC Cardiovascular Disorders

Research Article

Jiri Knot¹  Filip Rohac¹  Michal Smid²  Richard Rokyta²  Jan Pospisil²  Martin Poloczek³  Jindrich Spinar³  Jan Kanovsky³  Maria Holicka³  Tomas Ondrus³  Petr Kala³  Ladislav Dusek⁴  Jiri Jarkovsky⁴ 

[1] Cardiocenter, 3rd Faculty of Medicine, Charles University Prague, Prague, Czech Republic;Department of Cardiology, University Hospital Plzen and Faculty of Medicine Plzen, Charles University Prague, Prague, Czech Republic;Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic;Institute of Biostatistics and Analyses, Faculty of Science and Faculty of Medicine, Masaryk University, Brno, Czech Republic;

关键词: Percutaneous Coronary Intervention;    Acute Myocardial Infarction;    Coronary Angiography;    Acute Myocardial Infarction;    Primary Percutaneous Coronary Intervention;   

DOI  :  10.1186/1471-2261-12-31

 received in 2011-11-17, accepted in 2012-04-25,  发布年份 2012

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Kala et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.