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[Long-term prognosis after reperfusion therapy for acute myocardial infarction in elderly patients]
M Ishihara1, H Sato, T Kawagoe
1Department of Cardiology, Hiroshima City Hospital.
Insights
Achieving TIMI grade 3 flow after acute myocardial infarction significantly improves survival in elderly patients, similar to younger individuals. This crucial reperfusion endpoint benefits both age groups, highlighting its importance in cardiac care.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow is linked to better survival in non-elderly acute myocardial infarction (AMI) patients.
- The prognostic significance of TIMI grade 3 flow in elderly AMI patients remains unclear.
Purpose of the Study:
- To evaluate the impact of final TIMI grade 3 flow on survival in elderly patients following AMI.
- To compare the outcomes of elderly and non-elderly patients with AMI regarding reperfusion and mortality.
Main Methods:
- A cohort of 1,115 AMI patients undergoing coronary angiography within 24 hours were analyzed.
- Patients were stratified into elderly (≥75 years, n=131) and non-elderly (<75 years, n=984) groups.
- Cox proportional hazards models assessed predictors of 10-year cardiac death-free survival.
Main Results:
- Elderly patients had higher in-hospital mortality (25% vs 9%) and lower 10-year cardiac death-free rates.
- Final TIMI grade 3 flow was less frequent in elderly patients (53% vs 65%).
- Final TIMI grade 3 flow independently predicted improved 10-year cardiac death-free survival in both elderly (OR 0.39) and non-elderly (OR 0.41) patients.
Conclusions:
- Final TIMI grade 3 flow is a critical determinant of both short- and long-term survival after AMI in elderly patients.
- These findings underscore the importance of achieving optimal reperfusion in all age groups with AMI.
- The study supports the universal application of TIMI grade 3 flow as a therapeutic goal in AMI management.
Abstract:
Although it has been well demonstrated that TIMI grade 3 flow is associated with improved survival after acute myocardial infarction in non-elderly patients, its implication in elderly patients has not been clarified. To assess this issue, 1,115 patients with acute myocardial infarction who underwent coronary angiography within 24 hours after the onset of chest pain were studied: there were 131 elderly patients (age > or = 75 years) and 984 non-elderly patients (age < 75 years). Follow-up was achieved for 1,092 patients (98%). Elderly patients were associated with more female, Killip class > or = 2, 3 vessel disease and non-smokers. Although modality of reperfusion therapy was not different, final TIMI flow grade was less frequently obtained in elderly patients (53% vs 65%, p = 0.005). Elderly patients were associated with higher in-hospital mortality (25% vs 9%, p < 0.001) and lower 10 years cardiac death free rate (p < 0.001). Cox proportional hazards model showed that final TIMI flow grade 3 was an independent predictor of 10 years cardiac death free in elderly patients (odds ratio (OR) = 0.39, 95% confidence interval (CI) = 0.20-0.74, p = 0.004) as well as non-elderly patients (OR = 0.41, 95% CI = 0.29-0.58, p < 0.001). In conclusion, our data suggest that final TIMI grade 3 flow is an important determinant to improve short- and long-term survival after acute myocardial infarction in elderly patients as well as in non-elderly patients.