Myocardial infarction in patients over 90 years of age (original) (raw)
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Contemporary outcome of cardiac catheterizations in 1085 consecutive octogenarians
International Journal of Cardiology, 2004
Background: A growing number of patients [80 years require cardiac catheterization. Since little is known about the overall safety of these procedures in this population, we assessed the procedure-related risks and determined predictors for complications. Methods: We studied 1085 consecutive patients [80 years (82.6 F 2.6 years; 526 males, 544 females), who underwent 1384 cardiac catheterizations in a tertiary specialist university hospital (3% of 43 517 procedures). Results: A total of 373 patients (35%) required percutaneous coronary interventions (PCI), and 331 (31%) received coronary artery bypass surgery. Thirty-one patients died during hospital stay. Procedure-related complications including vascular injuries occurred in 2.1% after CATH and 11.6% after PCI. Conclusions: Despite the widespread notion that cardiac catheterization exposes patients [80 years to an unwarranted risk, these data demonstrate an acceptable complication rate. Patients [80 years of age should thus not be refused to undergo cardiac catheterization merely based on their age. D
Journal of Epidemiology and Public Health Reviews, 2017
Background: Women with ischemic heart disease (IHD) typically present less severe coronary artery atherosclerosis. Despite that, as compared with men, women maintain a worse outcome. This female susceptibility seems to be mainly related to older age of clinical presentation and heavier risk factors burden. Purpose: To investigate whether sex differences exist in the real-world management and clinical outcome of elderly patients with suspected IHD. Methods: Retrospective analysis of IHD elderly (≥ 80 years) patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina (SA). Management strategy, including invasive revascularization or a conservative medical approach, and outcome were evaluated. Results: A total of 1420 (41% women; mean age: 83.1 ± 2.8) IHD patients referring for ACS (43%) and SA (57%) were analyzed. Men more likely accessed for SA (59.6% vs 52.5%, p<0.001) whereas ACS was the most frequent reason for angiography in women (28.8% vs 21.5%, p<0.001). No significant sex differences in the burden of obstructive epicardial disease were observed in both ACS and SA patients. No sex disparities in antiplatelet therapy, specifically clopidogrel, were detected. Compared with SA men patients, female ones received more likely a conservative therapy (p=0.049). After a median (IQR) follow-up time of 39.0 (16-71) months, a total of 514 (36%) patients died. No sex differences in cardiac death (p=0.139) was observed. Nevertheless, the Kaplan Meier curves showed a trend in lower all-cause mortality in female group (p=0.093). Conclusions: In the very elderly population, an invasive strategy is superior to a conservative one in terms of survival rate. However, a dilution of the efficacy occurs with increasing age and comorbidities, and for male patients the benefit of the invasive strategy is not clear. Prospective studies are warranted to evaluate the net benefit of an invasive or a conservative approach in older population.
Predictors of early and late outcome of percutaneous coronary intervention in octogenarians
Acta Cardiologica, 2003
Objective-To evaluate the short and long-term results of percutaneous coronary interventions (PCI) in patients aged 80 years or older and to identify predictors of event-free survival. Methods and results-Clinical and angiographic data from all patients undergoing percutaneous coronary intervention in our institution are prospectively collected and stored in a computerized database. The clinical and angiographic characteristics of all patients aged 80 years or older undergoing percutaneous coronary intervention between January 1994 and December 1999 were analysed retrospectively. Follow-up was obtained by interview or through the referring physician. One hundred and fifty-eight patients aged 80 years or older (median: 83.4; range: 80.2-92.2) underwent percutaneous coronary intervention in our institution during the study period.The initial angiographic success rate was 92%. In-hospital mortality was 8.2% and procedural success 84.8%. One-year and two-year survival were 81% and 72.2% respectively, while event free survival at 1 year and 2 years was 65.8% and 57%. Using the Cox proportional hazards method, we identified incomplete revascularization and low left ventricular ejection fraction (LVEF) as predictors of death at 2 years. Complete revascularization and stenting were independent predictors of 2-year event-free survival. Conclusion-Percutaneous coronary intervention can be performed safely in octogenarians. Complete revascularization, stenting and preserved left ventricular ejection fraction were independent predictors of better outcome in this population.
Clinical Research in Cardiology, 2014
BACKGROUND With increasing life expectancy in the western world, the aging population will compose a significant portion of the demographic. Notably, cardiovascular disease is particularly prevalent in the elderly population. The aim of the present study is to investigate the outcomes of octogenarians referred for urgent coronary angiography in the setting of acute coronary syndromes (ACS). METHODS Between June 2007 and June 2012, consecutive patients with ACS were referred for evaluation and percutaneous intervention. Subsequently, the in-hospital death and major adverse cardiovascular events (MACE) at 30 days were analyzed. Multivariate analysis was performed to identify the predictors for death and MACE. RESULTS In patients 80 years (n = 296) ST-segment elevation myocardial infarction (STEMI) occurred in 46.6 %, non-ST-segment elevation myocardial infarction (NSTEMI) in 45.9 %, and 7.4 % had unstable angina. On the other hand, in patients <80 years (n = 2,316) STEMI was observed in 53.4 %, NSTEMI in 37.8 % and unstable angina in 9.0 %. The primary end-point of total mortality was significantly higher in octogenarians (7.4 vs. 4.5 %, p = 0.026). Similarly, the secondary end-point comprising overall MACE rate was significantly higher among the elderly (12.5 vs. 7.3 %, p = 0.002). Within the group of octogenarians, no relation between age and outcomes was noted (for death:
Archives of Gerontology and Geriatrics, 2010
A large number of data (Bounhoure et al., 2006) from the cardiovascular centers showed that PCI can significantly reduce not only the mortality but also the incidence of further ischemic events in the elderly patients with coronary heart disease (CHD). The survey found that 26.5% patients with PCI were the old patients (!75-year-old). However, taking into account that the coronary lesions were complex, as well as combined with pulmonary, renal and cerebrovascular disease, the old and very old patients with CHD accepted PCI more prudently. Between January 2003 and December 2007, 201 cases with PCI at our Geriatrics Cardiology Department were successively selected for this study to discuss the effect and safeness of PCI in the old and very old with CHD. 2. Patients and methods 2.1. Patient selection There were 105 men and 96 women in the study pool, the age range was 45-89 years and the mean age was 70.45 AE 9.31 (AES.D.) years. Among all the cases, there were 12 of acute myocardial infarction (AMI), 40 of old myocardial infarction, 79 of unstable angina pectoris, 43 of stable angina pectoris, and 25 of ischemic cardiomyopathy or asymptomatic CHD. All subjects were divided into the younger group (<60-year-old, 33 cases, mean age of 54.07 AE 5.29), the old group (60-to 74-year-old, 92 cases, mean age of 68.72 AE 4.10) and the very old group (75-to 89year-old, 76 cases, mean age was 78.33 AE 2.88). 201 cases of clinical and intervention data collected from in-patient, through the ST-DDSs medical imaging workstation v3.1 quantitative computer analysis system (QCA) to analyze quantitatively the degree of coronary stenosis. The severity of coronary atherosclerosis was quantitative determined by the Gensini score system (Gensini, 1983). 2.2. Exclusion criteria Serious infection, trauma; the coexistence of serious diseases such as liver and kidney dysfunction, coagulation dysfunction, cerebrovascular disease; malignant or other diseases which lead life expectancy does not exceed 1 year; angiography found vascular pathways were so serious tortuous and narrow that did not allow coronary intervention catheter to pass through.
The American Journal of Cardiology, 2001
Considerable data indicates that patients <50 years of age have lower morbidity and mortality after acute myocardial infarction (AMI) than older patients. It has been demonstrated that use of routine cardiac catheterization and revascularization in younger patients with AMI and successful thrombolysis does not confer benefit compared with a more conservative approach. Despite this, it has been our impression that cardiac catheterization is frequently employed in younger patients with AMI. Patients with uncomplicated initial AMI treated with thrombolytic therapy in the Second National Registry of Myocardial Infarction (NRMI-2) between June 1994 and April 1998 were identified. Patients were categorized into 4 age strata for purposes of analysis. A total of 61,232 cases met our inclusion criteria. Cardiac catheterization was performed during hospitalization in 78% of patients after an uncomplicated initial AMI. Age was inversely associated with receipt of cardiac catheterization: 85% of those <49 years old underwent catheterization compared with 63% of those >70 years old. Regression analysis revealed that use of catheterization was 2.9 times greater (95% confidence intervals 2.7 to 3.2) in patients <49 years old compared with those >70 years old. Geographic location and payor status also strongly influenced utilization of this procedure. In conclusion, routine coronary angiography after uncomplicated AMI is extensively utilized in all age groups, particularly in those <50 years of age. The efficacy and cost effectiveness of this strategy in these patients has not yet been determined in clinical trials. ᮊ2001 by
Percutaneous coronary intervention in the very elderly (≥85 years): trends and outcomes
British Journal of Cardiology, 2013
T his single-centre, retrospective, cohort study aims to provide insight into the long-term survival of patients ≥85 years old undergoing percutaneous coronary intervention (PCI) over a four-year observational period in a high-volume PCI centre. Between 2006 and 2010, 294 patients (mean age 88 ± 2 years, 56% male) underwent PCI at our institute. A total of 180 patients (61.2%) had an acute coronary syndrome (ACS) defined as unstable angina, non-ST elevation myocardial infarction (NSTEMI) or STelevation myocardial infarction (STEMI). One hundred and fourteen patients underwent PCI electively (38.8%). The primary outcome was all-cause 30-day and one-year mortality rates. In-hospital, 30-day and one-year mortality rates were 2.4% (7 patients), 4.4% (13 patients) and 17.7% (52 patients), respectively, in the entire cohort. In addition, 30-day (5.6% vs. 3.4%, p=0.24) and one-year (20.0% vs. 14.0%, p=0.19) mortality rates were similar between the ACS and elective patients, respectively. Following multi-variable analysis, age (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.04 to 1.26), male sex (HR 1.85, 95% CI 1.01 to 3.42), previous PCI (HR 2.74, 95% CI 1.36 to 5.56) and the presence of shock (HR 15.39, 95% CI 6.67 to 35.50) emerged as independent predictors of one-year mortality rates. We conclude that PCI appears to be a safe treatment option in very elderly patients with good one-year survival rates. Future randomised-controlled trials should specifically include this age group to guide interventional cardiologists in making decisions when faced with this very challenging cohort.
Arquivos Brasileiros de Cardiologia, 2002
To study the in-hospital evolution of patients aged 65 years and older, with acute myocardial infarction, who were treated by direct coronary angioplasty with no fibrinolytic therapy. Methods-We studied 885 patients divided into 2 groups as follows: group I (GI)-293 (33.4%) patients aged ≥ 65 years (72±5 years), and group II (GII)-592 patients aged < 65 years (57±9 years). Multivessel disease was more frequent in GI (63.5% x 49.7%; p=0.001). A greater number of GII patients were class I or II of the clinical Killip-Kimball classification (K) (80.2% x 67.2%; p=0.00002), while a significant number of GI patients were KIII and KIV (24.3% x 12.8%; p=0.00003). Results-Group I had a lower index of success (84.6% x 94%; p=0.0002) and a greater in-hospital mortality (12.2% x 4.7%; p=0.00007). The predictors of mortality in GI were as follows: previous infarction (20.5% x 6.3%; p=0.02), anterior location (13.4% x 6.4%; p=0.03), and male sex (10.4% x 4.4%; p=0.007). Conclusion-Elderly patients had more severe acute myocardial infarction and more extensive disease, a lower index of success, and greater in-hospital mortality. Previous infarction, anterior location and male sex were identified as predictors of mortality in the elderly group (GI).