Coronary artery disease
Comparison of 30-Day Outcomes in Patients <75 Years of Age Versus ≥75 Years of Age With Acute Myocardial Infarction Treated by Primary Coronary Angioplasty

https://doi.org/10.1016/j.amjcard.2006.05.023Get rights and content

We reviewed 1,087 consecutive patients treated by primary coronary angioplasty for acute myocardial infarction; 309 were ≥75 and 778 were <75 years of age. Compared with the younger group, the older group had higher 30-day (8.1% vs 4.0%, p = 0.0057) and cardiac (6.5% vs 3.6%, p = 0.038) mortality rates. Successful reperfusion was achieved in the 2 groups at a similarly high rate (91.6% and 92.9%, p = 0.45). Successful compared with unsuccessful angioplasty decreased 30-day mortality rates in the older group (6.0% vs 30.8%, p <0.0001) and in the younger group (3.2% vs 14.5%, p <0.0001). When reperfusion was successful, the cardiac mortality rate in older patients was not significantly greater than that in younger patients (4.6% vs 2.8%, p = 0.14). By multivariate analysis in all 1,087 patients, overt cardiogenic shock on admission (odds ratio 44.7, 95% confidence interval 22.0 to 91.1, p <0.0001) and unsuccessful reperfusion (odds ratio 9.40, 95% confidence interval 4.11 to 21.5, p <0.0001) were found to be independent predictors of 30-day mortality, whereas age ≥75 years (odds ratio 1.79, 95% confidence interval 0.91 to 3.50, p = 0.090) was not. In conclusion, aggressive angioplasty in older patients improves prognosis.

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Patient population

Between January 1999 and December 2002 in Kokura Memorial Hospital (Kitakyushu, Japan), 1,088 consecutive patients with AMI underwent primary coronary angioplasty within 12 hours of symptom onset or up to 48 hours if there was evidence of continuing ischemia. Patients met the following criteria: (1) ST-segment elevation or depression on an electrocardiogram consistent with AMI, (2) symptoms of myocardial ischemia lasting >20 minutes, and (3) creatine kinase increase >2 times the normal value.

Patient characteristics

Patients’ ages ranged from 27 to 102 years (mean 67.2 ± 11.7). There were some baseline differences. In the older group, women were >2 times as frequent. Older patients were less likely to have history of diabetes mellitus and hypercholesterolemia compared with younger patients. Overt cardiogenic shock on arrival was significantly more prevalent in older patients (Table 1).

Primary coronary angioplasty

Stenting was the equally dominant (>82% of patients) form of primary angioplasty, achieving successful reperfusion in about

Discussion

The main findings of the present study are that primary coronary angioplasty in older (≥75 years of age) patients is feasible, with a reperfusion success rate as high as that in the younger population. Practically all patients with failed reperfusion, regardless of age group, died from cardiac reasons within 30 days, and, if successful, reperfusion effectively decreased 30-day mortality to the point that cardiac mortality in older patients was not significantly higher than that in younger

Acknowledgment

We are indebted to Alfonso-T. Miyamoto, MD, for help with the report.

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