Abstract
Background: The majority of cardiovascular deaths occur in the elderly. The safety and results of primary infarct intervention in octogenarians is Not well characterized.
Hypothesis: The purpose of this study was to compare the results of primary infarct intervention in octogenarians with those in younger patients during 1997‐1998 and to compare these results to those obtained in octogenarians treated in 1991‐1994.
Methods: During 1997‐1998, 40 octogenarians were treated with primary infarct intervention and were compared with 60 randomly selected patients aged < 80 years treated during the same time period. The results in octogenarians were compared with the results in a group of 37 patients of similar age treated in 1991‐1994. The baseline characteristics, procedural results, and hospital outcome were obtained from a prospectively designed interventional database at a busy single‐center program.
Results: There was No significant difference in hospital survival between the two groups of patients treated in 1997‐1998 although there was a trend toward higher mortality in the octogenarian group. Length of stay and use of intra‐aortic balloon pumps were greater in the octogenarian group. When the results in octogenarians treated in 1997‐1998 were compared with the group of 37 patients treated in 1991‐1994, the hospital mortality declined from 27 to 10% (p = 0.05).
Conclusions: There has been improvement in hospital mortality over the past decade for patients aged ≥ 80 years treated with primary infarct intervention. Hospital resources and length of stay are greater for the octogenarian group. Ongoing research studies are comparing the results of thrombolytic therapy and primary intervention in aged patients.
Keywords: acute myocardial infarction, percutaneous transluminal coronary angioplasty, elderly, coronary stents, intraaortic balloon pump
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References
- 1. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O'Keefe J, Overlie P, Donohue B, Chelliah N, Timmis GC, Vlietstra RE, Strzelecki M, Puchrowicz‐Ochocki S, O'Neill WW: Primary Angioplasty in Myocardial Infarction Study Group : A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1993; 328:673–679 [DOI] [PubMed] [Google Scholar]
- 2. Weaver WD, Simes RJ, Betriu A, Grines CL, Zijlstra F, Garcia E, Grinfeld L, Gibbons RJ, Ribeiro EE, DeWood MA, Ribichini F: Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review. J Am Med Assoc 1997; 278:2093–2098 [PubMed] [Google Scholar]
- 3. Lee TC, Laramee LA, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Ligon RW, Hartzler GO: Emergency percutaneous transluminal coronary angioplasty for acute myocardial infarction in patients 70 years of age and older. Am J Cardiol 1990; 66:663–667 [DOI] [PubMed] [Google Scholar]
- 4. Holland KJ, O'Neill WW, Bates ER, Pitt B, Topol EJ: Emergency percutaneous transluminal coronary angioplasty during acute myocardial infarction for patients more than 70 years of age. Am J Cardiol 1989; 63:399–403. [DOI] [PubMed] [Google Scholar]
- 5. Yabe Y, Muramatsu T, Nakano H, Wagatsuma K: Efficacy and issues of emergent percutaneous transluminal coronary angioplasty—comparison of clinical results in younger and elderly patients. Angiology 1995; 12:1085–1095 [DOI] [PubMed] [Google Scholar]
- 6. Singh M, Mathew V, Garratt KN, Berger PB, Grill DE, Bell MR, Rihal CS, Holmes DR: Effect of age on the outcome of angioplasty for acute myocardial infarction among patients treated at the Mayo Clinic. Am J Med 2000; 108:187–192 [DOI] [PubMed] [Google Scholar]
- 7. DeGeare VS, Stone GW, Grines L, Brodie BR, Cox DA, Garcia E, Wharton TP, Boura JA, O'Neill WW, Grines CL: Angiographic and clinical characteristics associated with increased in‐hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the Primary Angioplasty in Myocardial Infarction Trials). Am J Cardiol 2000; 86:30–34 [DOI] [PubMed] [Google Scholar]
- 8. Berger AK, Radford MJ, Wang Y, Krumholz HM: Thrombolytic therapy in older patients. J Am Coll Cardiol 2000; 36:366–374 [DOI] [PubMed] [Google Scholar]