Abstract 20694: Clinical Outcome After Revascularization With Primary PCI in Elderly Presenting Acute ST-elevation Myocardial Infarction: A Single Center Registry
Objectives: We investigated the short- and long-term clinical outcome in elderly patients with ST-elevation myocardial infarction (MI) treated with primary stented angioplasty (PCI).
Methods: Between 2001–2008, all comers ≥75 years old (n=353) with ST- elevation MI treated with primary PCI were enrolled in the present registry. Primary end-points were short- (1month) and long-term mortality (2 years). Secondary end-points were recurrent MI, stroke, new revasularization (PCI and/or coronary artery bypass graft surgery) and new re-admission.
Results: In total, 167 patients died (47%) in a median follow up of 26.5 months. One-month and two-year mortality were 17.5% (n=62) and 28% (n= 100), respectively. Mortality was higher in the highest age tertile [60% for patients>81 years vs 46% for patients 78–81years vs 37% for patients less than 77 years, p=0.003]. Univariate and multivariate analysis to predict the mortality included the following parameters: age, gender, cardiogenic shock, ejection fraction, bare metal stenting, drug eluting stenting, thrombus aspiration, GPIIb/IIIa inhibitors. By multivariate analysis, only bare metal stent implantation (beta=−1.2, p=0.03) was an independent predictor of mortality. The incidence of recurrent MI, stroke and new revascularization was 15%, 5% and 35% respectively. Almost half of the patients (45%) required at least one readmission in the hospital for cardiac reasons and 37% for non-cardiac reasons (1.8/patient). Short- and long-term mortality rates did not change over time (figure). One-month mortality before the year 2003 (14%) was similar to one-month mortality the following years (20% in 2004–2006 and 17% after 2006, p=0.45).
Conclusions: Mortality rates in elderly patients undergoing primary PCI have not been improved over time. The incidence of major cardiovascular events and readmissions after the acute index event still remains high.
- © 2010 by American Heart Association, Inc.