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Brogan RA, Alabas O, Almudarra S, Hall M, Dondo TB, Mamas MA, Baxter PD, Batin PD, Curzen N, de Belder M, Ludman PF, Gale CP. Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2019; 8:68-77. [PMID: 28691534 PMCID: PMC7614829 DOI: 10.1177/2048872617710790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND: High survival rates are commonly reported following primary percutaneous coronary intervention for ST-elevation myocardial infarction, with most contemporary studies reporting overall survival. AIMS: The aim of this study was to describe survival following primary percutaneous coronary intervention for ST-elevation myocardial infarction corrected for non-cardiovascular deaths by reporting relative survival and investigate clinically significant factors associated with poor long-term outcomes. METHODS AND RESULTS: Using the prospective UK Percutaneous Coronary Intervention registry, primary percutaneous coronary intervention cases ( n=88,188; 2005-2013) were matched to mortality data for the UK populace. Crude five-year relative survival was 87.1% for the patients undergoing primary percutaneous coronary intervention and 94.7% for patients <55 years. Increasing age was associated with excess mortality up to four years following primary percutaneous coronary intervention (56-65 years: excess mortality rate ratio 1.61, 95% confidence interval 1.46-1.79; 66-75 years: 2.49, 2.26-2.75; >75 years: 4.69, 4.27-5.16). After four years, there was no excess mortality for ages 56-65 years (excess mortality rate ratio 1.27, 0.95-1.70), but persisting excess mortality for older groups (66-75 years: excess mortality rate ratio 1.72, 1.30-2.27; >75 years: 1.66, 1.15-2.41). Excess mortality was associated with cardiogenic shock (excess mortality rate ratio 6.10, 5.72-6.50), renal failure (2.52, 2.27-2.81), left main stem stenosis (1.67, 1.54-1.81), diabetes (1.58, 1.47-1.69), previous myocardial infarction (1.52, 1.40-1.65) and female sex (1.33, 1.26-1.41); whereas stent deployment (0.46, 0.42-0.50) especially drug eluting stents (0.27, 0.45-0.55), radial access (0.70, 0.63-0.71) and previous percutaneous coronary intervention (0.67, 0.60-0.75) were protective. CONCLUSIONS: Following primary percutaneous coronary intervention for ST-elevation myocardial infarction, long-term cardiovascular survival is excellent. Failure to account for non-cardiovascular death may result in an underestimation of the efficacy of primary percutaneous coronary intervention.
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Affiliation(s)
- Richard A Brogan
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Oras Alabas
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sami Almudarra
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Marlous Hall
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tatendashe B Dondo
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Royal Stoke Hospital, UK
| | - Paul D Baxter
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Phillip D Batin
- Department of Cardiology, Pinderfields Hospital, Wakefield, UK
| | - Nick Curzen
- University Hospital Southampton NHS FT & Faculty of Medicine, UK
| | - Mark de Belder
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Chris P Gale
- MRC Medical Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
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Sappa R, Grillo MT, Cinquetti M, Prati G, Spedicato L, Nucifora G, Perkan A, Zanuttini D, Sinagra G, Proclemer A. Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Int J Cardiol 2017; 249:112-118. [PMID: 28935461 DOI: 10.1016/j.ijcard.2017.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 07/04/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). METHODS AND RESULTS We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. CONCLUSIONS PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.
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Affiliation(s)
- Roberta Sappa
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy.
| | - Maria Teresa Grillo
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Martino Cinquetti
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Giulio Prati
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Leonardo Spedicato
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Gaetano Nucifora
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Andrea Perkan
- Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy
| | - Davide Zanuttini
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Gianfranco Sinagra
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy; Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy
| | - Alessandro Proclemer
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
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3
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Peiyuan H, Jingang Y, Haiyan X, Xiaojin G, Ying X, Yuan W, Wei L, Yang W, Xinran T, Ruohua Y, Chen J, Lei S, Xuan Z, Rui F, Yunqing Y, Qiuting D, Hui S, Xinxin Y, Runlin G, Yuejin Y. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry. PLoS One 2016; 11:e0165672. [PMID: 27812152 PMCID: PMC5094717 DOI: 10.1371/journal.pone.0165672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population. Methods Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups. Results Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not. Conclusions Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.
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Affiliation(s)
- He Peiyuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Jingang
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xu Haiyan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gao Xiaojin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xian Ying
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America
| | - Wu Yuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Li Wei
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wang Yang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Tang Xinran
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yan Ruohua
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jin Chen
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Song Lei
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhang Xuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Fu Rui
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Ye Yunqing
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dong Qiuting
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Sun Hui
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yan Xinxin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gao Runlin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Yuejin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- * E-mail:
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Schoos MM, Sejersten M, Baber U, Treschow PM, Madsen M, Hvelplund A, Kelbæk H, Mehran R, Clemmensen P. Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease. Am J Cardiol 2015; 115:13-20. [PMID: 25456866 DOI: 10.1016/j.amjcard.2014.09.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022]
Abstract
Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials and registries are subject to selection biases. We aimed to describe the prevalence and prognosis of acute CV disease and the effect of invasive treatment, in an unselected and consecutive prehospital cohort of 3,410 patients calling the national emergency telephone number from 2005 to 2008 with follow-up in 2013. Individual-level data from national registries were linked to the dedicated EMS database of primary ambulance dispatches supported by physician-manned emergency units. Outcome data were obtained from the Central Population Registry, the National Patient Registry, and the National Registry of Causes of Death. In patients calling the national emergency telephone number, a CV related ambulance alarm code was given in 2,541 patients of 3,410 patients (74.5%) resulting in 2,056 of 3,410 primary CV discharge diagnoses (60.3%) with a 30-day and 5-year all-cause mortality of 24.5% and 46.4%, respectively. Stroke, acute heart failure, and ST-segment elevation myocardial infarction (STEMI) carried a 25- to 50-fold adjusted mortality hazard during the first 4 days. In patients with suspected STEMI, 90.5% had an acute angiography performed. Nontransferred, nonreperfused patients with STEMI (9.1%) carried 80% short-term mortality. Noninvasive management of non-ST-segment elevation myocardial infarction was common (37.9%) and associated with an increased adjusted long-term mortality hazard (hazard ratio 4.17 [2.51 to 8.08], p <0.001). Survival in 447 out-of-hospital cardiac arrest patients (13.1%) was 11.6% at 30 days. In conclusion, patients with a CV ambulance alarm call code and a final CV discharge diagnosis constitute most patients handled by EMS with an extremely elevated short-term mortality hazard and a poor long-term prognosis. Although co-morbidities and frailty may influence triage, this study emphasizes the need for an efficient prehospital phase with focus on CV disease and proper triage of patients suitable for invasive evaluation if the outcomes of acute heart disease are to be improved further in the current international context of hospitals merging into highly specialized entities resulting in longer patient transfers.
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Affiliation(s)
- Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark; Department of Cardiology, Køge Hospital, University of Copenhagen, Denmark; Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Maria Sejersten
- Department of Cardiology, Roskilde Hospital, University of Copenhagen, Denmark
| | - Usman Baber
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Mette Madsen
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Henning Kelbæk
- Department of Cardiology, Roskilde Hospital, University of Copenhagen, Denmark
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York
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5
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Showkathali R, Boston-Griffiths E, Parker M, Davies JR, Clesham GJ, Sayer JW, Kelly PA, Aggarwal RK. Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting with ST elevation myocardial infarction? J Cardiovasc Med (Hagerstown) 2014; 15:53-9. [PMID: 24500237 DOI: 10.2459/jcm.0b013e3283649978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Very few randomized trials have analysed the outcome of primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) in very elderly patients (≥80 years). An observational study was performed to evaluate the outcome of PPCI in patients of at least 80 years of age who were admitted to our unit. METHODS We included all patients undergoing PPCI in our unit from September 2009 to November 2011. RESULTS Of the 1471 patients who underwent PPCI during the study period, 236 (16%) were at least 80 years of age. The mean age was 85 ± 4 years (range 80-99 years, median 85 years). There was a significant difference in in-hospital mortality [14.4 vs. 2.9%, odds ratio (OR) 5.6, 95% confidence interval (CI) 3.4-9.2, P <0.0001], 30-day mortality (20.3 vs. 4%, OR 6.2, 95% CI 4.0-9.5, P <0.0001), 1-year mortality (28.8 vs. 6.2%, OR 6.1, 95% CI 4.2-8.8, P <0.0001), 30-day stent thrombosis (1.7 vs. 0.4%, OR 4.2, 95% CI 1.1-15.9, P = 0.04) and non-coronary artery bypass grafting major bleed (5.9 vs. 3%, OR 2, 95% CI 1.1-3.8, P = 0.03) between patients aged at least 80 years and those less than 80 years. CONCLUSION The mortality in our patients of at least 80 years was similar to the previously published data, despite the advances in PPCI procedures. Considering the increasing number of octogenarian patients with STEMI at the present time, there is a need for a randomized trial to compare the different treatment strategies for STEMI.
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Affiliation(s)
- Refai Showkathali
- aDepartment of Cardiology, The Essex Cardiothoracic Centre, Essex bAnglia Ruskin University, Chelmsford, UK
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6
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Plakht Y, Shiyovich A, Gilutz H. Predictors of long-term (10-year) mortality postmyocardial infarction: age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project. J Cardiol 2014; 65:216-23. [PMID: 24994020 DOI: 10.1016/j.jjcc.2014.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death in elderly people. Over the past decades medical advancements in the management of patients with acute myocardial infarction (AMI) led to improved survival and increased life expectancy. As short-term survival from AMI improves, more attention is being shifted toward understanding and improving long-term outcomes. AIM To evaluate age-associated variations in the long-term (up to 10 years) prognostic factors following AMI in "real world" patients, focusing on improving risk stratification of elderly patients. METHODS A retrospective analysis of 2763 consecutive AMI patients according to age groups: ≤65 years (n=1230) and >65 years (n=1533). Data were collected from the hospital's computerized systems. The primary outcome was 10-year postdischarge all-cause mortality. RESULTS Higher rates of women, non-ST-elevation AMI, and most comorbidities were found in elderly patients, while the rates of invasive treatment were lower. During the follow-up period, mortality rate was higher among the older versus the younger group (69.7% versus 18.6%). Some of the parameters included in the interaction multivariate model had stronger association with the outcome in the younger group (hyponatremia, anemia, alcohol abuse or drug addiction, malignant neoplasm, renal disease, previous myocardial infarction, and invasive interventions) while others were stronger predictors in the elderly group (higher age, left main coronary artery or three-vessel disease, and neurological disorders). The c-statistic values of the multivariate models were 0.75 and 0.74 in the younger and the elder groups, respectively, and 0.86 for the interaction model. CONCLUSIONS Long-term mortality following AMI in young as well as elderly patients can be predicted from simple, easily accessible clinical information. The associations of most predictors and mortality were stronger in younger patients. These predictors can be used for optimizing patient care aiming at mortality reduction.
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Affiliation(s)
- Ygal Plakht
- Nursing Research Unit, Soroka University Medical Center, Beer-Sheva, Israel; Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Arthur Shiyovich
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Harel Gilutz
- Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel
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7
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Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry. Clin Res Cardiol 2013; 102:837-45. [DOI: 10.1007/s00392-013-0600-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Wu X, Yang D, Zhao Y, Lu C, Wang Y. Effectiveness of percutaneous coronary intervention within 12 hours to 28 days of ST-elevation myocardial infarction in a real-world Chinese population. PLoS One 2013; 8:e58382. [PMID: 23554888 PMCID: PMC3595272 DOI: 10.1371/journal.pone.0058382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/04/2013] [Indexed: 11/24/2022] Open
Abstract
Objectives Percutaneous coronary intervention( PCI) for ST-elevation myocardial infarction (STEMI) has been widely accepted for patient who come within 12 hours, but for those who come to the hospital late (12 hours to 28 days) the long-term data and possible predictors are limited regarding ‘hard’ endpoints in ‘real world’. Methods The registry data of all 5523 consecutive patients admitted due to an incident STEMI (12 hours to 28 days) in our center were analyzed. Patients were divided into 3 age groups (age<65; age = 65–74; age ≥75) and two therapeutic groups including conservative and PCI group. The primary endpoints included 30-day mortality and 1-year mortality. Results The clinical characteristics include female gender; history of diabetes mellitus, previous myocardial infarction, cerebral vascular disease, chronic renal failure, atrial fibrillation, hypertension, anemia, gastric bleeding; presentation of ventricular tachycardia/ventricular fibrillation, pneumonia, heart failure, multiple organ failure and cardiogenic shock. The ratio of all the above factors increased with the age getting older (all p<0.05), while that of the PCI decreased significantly with ageing (53.9%, 36.3% and 21.7%). Except hypertension, all the other factors were less seen in the PCI group than in the conservative group (p<0.01). Pooled estimates, based on type of therapy and age groups, PCI resulted in significantly lower 30-day and 1-year mortality. Cox analysis showed the positive predictors for 30 days and 1 year mortality were heart failure, cerebral vascular disease, chronic renal failure, ventricular tachycardia/ventricular fibrillation, age, female, gastric intestinal bleeding, cardiogenic shock, multiple organ failure, while PCI was a negative predictor. ROCs analysis showed AUCs were always higher for PCI group. Conclusions The elderly have more comorbidities and higher rates of mortality, mandating thorough evaluation before acceptance for PCI. PCI between 12 hours to 28 days in all ages of patients including the elderly with STEMI is significantly more effective than conservative therapy.
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Affiliation(s)
- Xingli Wu
- Institute of Geriatric Cardiology, China PLA General Hospital, Beijing, China.
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9
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Antonsen L, Jensen LO, Terkelsen CJ, Tilsted HH, Junker A, Maeng M, Hansen KN, Lassen JF, Thuesen L, Thayssen P. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: From the Western Denmark heart registry. Catheter Cardiovasc Interv 2013; 81:912-9. [DOI: 10.1002/ccd.24591] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/26/2012] [Accepted: 07/30/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Lisbeth Antonsen
- Department of Cardiology; Odense University Hospital; Odense; Denmark
| | | | | | | | - Anders Junker
- Department of Cardiology; Odense University Hospital; Odense; Denmark
| | - Michael Maeng
- Department of Cardiology; Aarhus University Hospital; Skejby; Aarhus; Denmark
| | | | | | - Leif Thuesen
- Department of Cardiology; Aarhus University Hospital; Skejby; Aarhus; Denmark
| | - Per Thayssen
- Department of Cardiology; Odense University Hospital; Odense; Denmark
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Lazzeri C, Valente S, Chiostri M, Attanà P, Picariello C, Gensini GF. Trends in mortality rates in elderly ST elevation myocardial infarction patients submitted to primary percutaneous coronary intervention: A 7-year single-center experience. Geriatr Gerontol Int 2012; 13:711-7. [DOI: 10.1111/ggi.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Serafina Valente
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Marco Chiostri
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Paola Attanà
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Claudio Picariello
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Gian Franco Gensini
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
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Medina HM, Cannon CP, Fonarow GC, Grau-Sepulveda MV, Hernandez AF, Frank Peacock W, Laskey W, Peterson ED, Schwamm L, Bhatt DL. Reperfusion strategies and quality of care in 5339 patients age 80 years or older presenting with ST-elevation myocardial infarction: analysis from get with the guidelines-coronary artery disease. Clin Cardiol 2012; 35:632-40. [PMID: 22744844 DOI: 10.1002/clc.22036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/31/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Data regarding reperfusion strategies, adherence to national guidelines, and in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients age ≥80 years are limited. The aim of this study was to determine current reperfusion trends, medical treatment, and in-hospital mortality during STEMI in older adults. HYPOTHESIS Among patients aged 80 or above presenting with STEMI, adherence to guidelines, length of stay, and in-hospital mortality would be better in those receiving reperfusion versus those who did not. METHODS Using the Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) database, we examined care and in-hospital outcomes of STEMI patients ≥80 years old. Use of evidence-based therapies and quality measures were analyzed by reperfusion strategies. RESULTS A total of 5339 patients age ≥80 years hospitalized with STEMI were included. Of these, 42.8% (n = 2285) underwent primary percutaneous coronary intervention (PPCI), 4.8% (n = 255) underwent thrombolysis (TL), and 52.4% (n = 2799) received no reperfusion (NR). Patients with NR were more likely to be older, female, have lower body mass index, and higher prevalence of renal insufficiency and heart failure compared with PPCI or TL patients. During the last decade, there was a significant increase in the use of PPCI compared with TL as the main reperfusion strategy in this population. Adjusted in-hospital mortality in PPCI patients was lower compared with NR patients (odds ratio [OR]: 0.41, 95% confidence interval [CI]: 0.35-0.49); also, patients undergoing PPCI or TL had lower mortality compared with NR patients (OR: 0.47, 95% CI: 0.40-0.55). CONCLUSIONS Among patients ≥80 years old admitted with STEMI to GWTG-CAD hospitals, less than half undergo mechanical or pharmacological reperfusion. However, the proportion of patients undergoing PPCI has increased substantially over the 8-year study period. Patients undergoing PPCI or TL had lower in-hospital mortality compared with the NR strategy.
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Affiliation(s)
- Hector M Medina
- Department of Medicine, Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
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Age-related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era. BMC Cardiovasc Disord 2012; 12:31. [PMID: 22533539 PMCID: PMC3407529 DOI: 10.1186/1471-2261-12-31] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 04/25/2012] [Indexed: 12/22/2022] Open
Abstract
Background Older 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. Methods Retrospective 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. Results The 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. Conclusions In 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.
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Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization. Int J Cardiol 2011; 155:66-9. [PMID: 21345499 DOI: 10.1016/j.ijcard.2011.01.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/01/2011] [Indexed: 12/22/2022]
Abstract
Though age is a predictor of adverse events after acute coronary syndrome, including in-hospital and post-hospital mortality rates, elderly patients are under-represented in randomized trials evaluating strategies of early coronary revascularization in acute myocardial infarction. Several factors can account for the unfavorable outcome of the elderly, comprising increased glucose values. Diabetes is more common in the elderly patients with acute myocardial infarction in respect to younger patients and elevated glucose, though common, are rarely treated and associated with increased mortality, particularly in those without recognized diabetes. Age itself is thought to affect the acute glucose response to stress. Human aging is associated with impaired β-cell sensitivity to glucose and impaired β-cell compensation to insulin resistance and older people exhibit an impaired glucose response after injury characterized by a more marked increases in endogenous glucose production. In the early phase of ST elevation myocardial infarction (STEMI), the acute glucose response to stress comprises not only hyperglycemia but also insulin-resistance (assessed by the Homeostatic Model Assessment). Recently it has been documented in 346 STEMI patients submitted to mechanical revascularization that the acute glucose response to myocardial injury differs in respect to age, since older patients showed the highest glucose levels and the poorest glycemic control during ICCU stay in the lack of differences in insulin resistance incidence. Taking into account that aging impairs the acute glucose response to stress in elderly STEMI patients, further studies are needed to establish whether a different (more aggressive) therapeutic regime is needed in this subgroup of patients at higher risk.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134 Florence, Italy.
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Díaz-Castro Ó, Datino T, López-Palop R, Martínez-Sellés M. [Update on geriatric cardiology]. Rev Esp Cardiol 2011; 64 Suppl 1:3-12. [PMID: 21276485 DOI: 10.1016/s0300-8932(11)70002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article contains a review of the main developments in the field of geriatric cardiology reported during 2010. The focus is on research into the specific characteristics of elderly patients with heart failure, ischemic heart disease, valvular heart disease and arrhythmias.
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Affiliation(s)
- Óscar Díaz-Castro
- Servicio de Cardiología, Hospital do Meixoeiro, CHUVI, Vigo, Pontevedra, España
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Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF. Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience. Intern Emerg Med 2011; 6:41-6. [PMID: 20853070 DOI: 10.1007/s11739-010-0459-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 08/31/2010] [Indexed: 12/19/2022]
Abstract
Elderly patients are under-represented in trials assessing strategies of early coronary revascularization in acute myocardial infarction, though they are the fastest growing segment of our population. The aims of the present investigation, performed in 357 elderly (≥75 years) patients with ST elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) consecutively admitted to our Intensive Cardiac Care Unit (ICCU) from 1 January 2006 to 31 December 2009, were as follows: (a) to identify predictors for in-ICCU mortality among clinical, angiographic and metabolic factors and (b) to evaluate whether there are gender-related differences in management, outcome and in the metabolic and inflammatory responses to acute myocardial ischemia. At multivariable backward stepwise logistic regression analysis, the following variables were independent predictors for in-ICCU mortality in the overall population: age (OR 1.15; 95% CI 1.05-1.27; p < 0.003), admission glycemia (OR 2.24; 95% CI 1.41-3.56; p < 0.001), left ventricular ejection fraction (LVEF) (OR 0.92; 95% CI 0.88-0.97; p < 0.001), primary PCI failure (OR 4.70; 95% CI 1.70-12.98; p < 0.003). In elderly STEMI patients submitted to primary PCI, early mortality can be related to age, hemodynamic derangement (as indicated by LVEF), the rate of procedural success, and increased glucose values. No gender-related differences in management were detectable in our series. Our data strongly suggest that, in elderly patients in the acute phase of STEMI, since hyperglycemia is a modifying factor, glucose values deserve a more intensive treatment. Further studies, performed specifically in elderly STEMI patients, should be addressed to identify the glucose cut-off values able to influence the outcome.
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Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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