Related Experiment Videos
Systematic primary angioplasty in octogenarian and older patients
D Antoniucci1, R Valenti, G M Santoro
1Division of Cardiology, Careggi Hospital, Florence, Italy.
Insights
Primary percutaneous transluminal coronary angioplasty (PTCA) is effective in octogenarians with acute myocardial infarction (AMI). This aggressive strategy shows benefits for very elderly patients, supporting early intervention despite risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Conflicting data exist on aggressive treatment for high-risk acute myocardial infarction (AMI) patients, particularly the elderly.
- This study addresses the efficacy of early intervention in octogenarian and older AMI patients.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) in patients aged 80 and above with AMI.
- To determine the safety and effectiveness of an aggressive treatment strategy in this elderly, high-risk population.
Main Methods:
- A 3-year retrospective analysis of 55 octogenarian/older patients who underwent primary PTCA for AMI.
- Primary PTCA was performed without age restriction as part of systematic AMI care.
Main Results:
- An optimal acute angiographic result was achieved in 93% of patients; stenting was performed in 60%.
- The 30-day mortality rate was 16%, significantly higher in patients with cardiogenic shock (70%) versus those without (4%).
- The 1-year survival rate was 77%, with recurrent ischemia in 13%.
Conclusions:
- Primary PTCA benefits extend to the very elderly with AMI.
- An early aggressive strategy is supported for octogenarian and older patients with acute myocardial infarction.
Background:
There are conflicting data about the efficacy of aggressive treatment and early intervention among high-risk patients with acute myocardial infarction (AMI), such as elderly patients. This study sought to determine the short- and long-term outcome of octogenarian and older patients after primary percutaneous transluminal coronary angioplasty (PTCA).
Methods:
In our tertiary referral center a program of primary PTCA was begun in 1995, and the systematic care for AMI included primary PTCA in all patients with AMI, with no age restriction. Over a period of 3 years, 55 octogenarian or older patients underwent primary PTCA.
Results:
Between January 1995 and July 1998, 719 patients with AMI underwent primary PTCA. Of these, 55 patients were octogenarians or older (mean age, 84 +/- 3 years). Primary PTCA failure occurred in 3 (5%) patients. An optimal acute angiographic result was achieved in 51 (93%) patients. Stenting of the infarct vessel was accomplished in 33 (60%) patients. The 30-day mortality rate was 16%. The mortality rate was 4% in patients without cardiogenic shock on presentation and 70% in patients with cardiogenic shock. The recurrent ischemia rate was 13% and resulted in nonfatal reinfarction in 2 patients and repeat PTCA in 5 patients. As determined by multivariate analysis, an optimal acute angiographic result and cardiogenic shock were significantly related to mortality. The 1-year survival rate was 77%.
Conclusions:
The results of this study suggest that the benefits of primary PTCA apply to the very elderly and support an early aggressive strategy for this high-risk patient subset.