Influence of Age on Long-Term Outcome After Emergent Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction
- Volume 22 - Issue 6 - June, 2010
- Posted on: 6/2/10
- 0 Comments
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ABSTRACT: Background. Percutaneous coronary intervention (PCI) provides advantages compared to thrombolytic therapy in the treatment of ST-elevation myocardial infarction (STEMI). Elderly patients have increased in-hospital mortality; the predictors of adverse outcomes are not well established, with limited data available regarding late follow up of these patients. We evaluated early and late outcomes of patients undergoing emergent PCI for STEMI to identify the predictors of subsequent late adverse events and, in particular, determine if age alone was a predictor of an adverse outcome. Materials and Methods. A retrospective review of all patients referred for emergent PCI for STEMI to a single tertiary referral center was performed. All patients undergoing primary PCI for STEMI or rescue PCI for failed thrombolysis between December 2003 and December 2007 were included for assessment. Results. During the study period, 269 patients underwent primary or rescue PCI for STEMI. Patients ≥ 70 years of age were more likely to have established cardiovascular risk factors and documented coronary artery disease. Thrombolysis in myocardial infarction (TIMI) 3 flow predicted a good outcome, whereas recurrent ischemia in hospital, prior aspirin therapy and discharge creatinine predicted a poor outcome; age alone was not an adverse prognostic factor. Conclusions. The increased mortality in elderly patients undergoing PCI for STEMI reflects comorbidity and suboptimal procedural out- comes rather than any age effect per se. Future approaches to optimize the management of STEMI in the elderly should include identification of those patients most likely to benefit from an invasive approach.
J INVASIVE CARDIOL 2010;22:273–277
Primary percutaneous coronary intervention (PCI) remains the standard of care for patients presenting with ST-elevation myocardial infarction (STEMI) at centers capable for performing emergent PCI.1 PCI offers advantages in terms of recurrent ischemia and the risk of hemorrhagic stroke compared to thrombolytic therapy. There is also strong evidence supporting the use of PCI as rescue therapy in cases of failed thrombolytic therapy for STEMI,2 as well as in patients with cardiogenic shock complicating MI, including the elderly.3 However, elderly patients (> 70 years of age) are a unique population, previously underrepresented in clinical trials.4 While in-hospital mortality is noted to be higher in the elderly, the predictors of adverse outcomes are not well established. In addition, there are limited data regarding late follow up of these patients, particularly in the contemporary setting.
We sought to evaluate the early and late outcomes of elderly patients undergoing emergent PCI for STEMI and to identify the predictors of subsequent adverse events in a single tertiary referral center with primary PCI facilities.