Details

Autor(en) / Beteiligte

• Sakai, Koyu
• Nagayama, Shinya
• Ihara, Kasumi
• Ando, Kenji
• Shirai, Shinichi
• Kondo, Katsuhiro
• Yokoi, Hiroyoshi
• Iwabuchi, Masashi
• Nosaka, Hideyuki
• Nobuyoshi, Masakiyo

Titel

Primary percutaneous coronary intervention for acute myocardial infarction in the elderly aged ≥75 years

Ist Teil von

• Catheterization and cardiovascular interventions, 2012-01, Vol.79 (1), p.50-56

Ort / Verlag

Hoboken: Wiley Subscription Services, Inc., A Wiley Company

Erscheinungsjahr

2012

Quelle

Wiley HSS Collection

Beschreibungen/Notizen

• Objectives: We aimed to see whether primary percutaneous coronary intervention (PCI) benefits for ST‐segment elevation myocardial infarction (STEMI) in the aged could be validated. Background: Primary PCI benefits in elderly patients with STEMI remain uncertain. Methods: We reviewed 947 consecutive patients treated with primary PCI for STEMI: 331 were aged ≥75 years (older) and 616 <75 years (younger). Results: The older group had higher percentage of renal insufficiency (7.9% vs. 3.1%, P = 0.0010), prior stroke (9.4% vs. 3.9%, P = 0.0006), 30‐day mortality rate (7.6% vs. 3.9%, P = 0.015), and cardiac mortality rate (6.6% vs. 3.7%, P = 0.045). Successful reperfusion rates were similarly high in both groups (90.0% and 92.7%, P = 0.16), despite the higher proportion of patients with door‐to‐balloon time >90 min (15% vs. 8.4%, P = 0.0016) in older patients. Successful compared with unsuccessful PCI significantly decreased 30‐day mortality rates in the older group (6.0% vs. 21%, P = 0.0018) and in the younger group (2.8% vs. 18%, P < 0.0001). When reperfusion was successful, cardiac mortality rate in older patients was not significantly greater than in younger patients (5.4% vs. 2.8%, P = 0.057). By multivariate analysis, unsuccessful reperfusion independently predicted 30‐day mortality (odds ratio, 4.04; 95% confidence interval, 1.79–9.12; P = 0.0008), whereas age ≥75 years (odds ratio, 1.00; 95% confidence interval, 0.41–2.41; P = 0.99) and door‐to‐balloon time >90 min (odds ratio, 1.78; 95% confidence interval, 0.76–4.20; P = 0.19) did not. Conclusions: Pre‐existing comorbidities characterize older patients developing STEMI. Aggressive PCI in older patients improves prognosis, and short door‐to‐balloon time is an important parameter conditioning the prognosis. © 2011 Wiley Periodicals, Inc.