Published Online
on September 7, 2004

A more recent version of this article appeared on September 21, 2004

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Submitted on April 14, 2004
Revised on June 24, 2004
Accepted on July 21, 2004

Outcome in Elderly Patients Undergoing Primary Coronary Intervention for Acute Myocardial Infarction. Results From the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial

Giulio Guagliumi MD, Gregg W. Stone MD^*, David A. Cox MD, Thomas Stuckey MD, James E. Tcheng MD, Mark Turco MD, Giuseppe Musumeci MD, John J. Griffin MD, Alexandra J. Lansky MD, Roxana Mehran MD, Cindy L. Grines MD, and Eulogio Garcia MD

From Ospedali Riuniti di Bergamo, Bergamo, Italy (G.G., G.M.); Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY (G.W.S., A.L., R.M.); Mid Carolina Cardiology, Charlotte, NC (D.A.C.); Moses Cone Memorial Hospital, Greensboro, NC (T.S.); Duke Clinical Research Institute, Durham, NC (J.E.T.); Washington Adventist Hospital, Tacoma Park, Md (M.T.); Virginia Beach General Hospital, Virginia Beach, Va (J.J.G.); William Beaumont Hospital, Royal Oak, Mich (C.L.G.); and Hospital Gregorio Maranon, Madrid, Spain (E.G.).

^* To whom correspondence should be addressed. E-mail: gstone{at}crf.org.

Background--Biological age is a strong determinant of prognosis in patients with acute myocardial infarction (AMI). We sought to examine the impact of age after primary percutaneous coronary intervention in AMI and to determine whether routine coronary stent implantation and/or platelet glycoprotein IIb/IIIa inhibitors improve clinical outcomes in elderly patients after primary angioplasty.

Methods and Results--In the CADILLAC trial, 2082 patients with AMI were randomized to balloon angioplasty, angioplasty plus abciximab, stenting alone, or stenting plus abciximab. No patient was excluded on the basis of advanced age; patients ranging from 21 to 95 years of age were enrolled. One-year mortality increased for each decile of age, exponentially after 65 years of age (1.6% for patients <55 years, 2.1% for 55 to 65 years, 7.1% for 65 to 75 years, 11.1% for patients >75 years; P<0.0001). Elderly patients also had increased rates of stroke and major bleeding compared with their younger counterparts. Among elderly patients (65 years), 1-year rates of ischemic target revascularization (7.0% versus 17.6%; P<0.0001) and subacute or late thrombosis (0% versus 2.2%; P=0.005) were reduced with stenting compared with balloon angioplasty. Routine abciximab administration, although safe, was not of definite benefit in elderly patients. Rates of mortality, reinfarction, disabling stroke, and major bleeding in the elderly were independent of reperfusion modality.

Conclusions--Despite contemporary mechanical reperfusion strategies, mortality, major bleeding, and stroke rates remain high in elderly patients undergoing primary percutaneous coronary intervention, outcomes that are not affected by stents or glycoprotein IIb/IIIa inhibitors. By reducing restenosis, however, stent implantation improves clinical outcomes in elderly patients with AMI.

Key words: myocardial infarction • platelet aggregation inhibitors • stents

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