[Acute ST-elevation myocardial infarction in the elderly (>75 years). Results from a regional multicenter study]
G Dangelser1, Y Gottwalles, M Huk
1USIC, Groupe hospitalier privé du Centre Alsace, Clinique Saint-Joseph, Colmar. gaetan.dangelser@hotmail.com
Insights
Percutaneous coronary angioplasty (PTCA) is effective for elderly ST-elevation myocardial infarction (STEMI) patients in Alsace. This study shows high reperfusion rates and feasibility in this high-risk group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- ST-elevation myocardial infarction (STEMI) poses significant risks, particularly for elderly patients.
- Limited data exists on the feasibility and outcomes of percutaneous coronary angioplasty (PTCA) in elderly STEMI patients in nonacademic centers.
- Regional healthcare specificities may influence treatment accessibility and outcomes.
Purpose of the Study:
- To assess the prevalence and feasibility of primary percutaneous coronary angioplasty (PTCA) in the acute phase of ST-elevation myocardial infarction (STEMI).
- To evaluate the outcomes of PTCA in elderly STEMI patients (≥75 years) compared to younger patients.
- To analyze revascularization rates and adverse events in different age groups.
Main Methods:
- Prospective, multicenter study in 3 nonacademic interventional cardiology centers.
- Inclusion of all STEMI patients admitted during the study period.
- Comparison of clinical characteristics, angiographic data, PTCA results, revascularization rates, and adverse events between elderly (≥75 years) and younger patients.
Main Results:
- Elderly patients (20.45% of STEMI admissions) presented with more comorbidities and three-vessel disease.
- Mortality in the elderly subgroup was 20.47%, significantly reduced to 5.41% when excluding severe cases (cardiogenic shock, Killip stage III, resuscitation).
- High reperfusion rates were achieved with PTCA in the elderly (93.88% TIMI III flow), comparable to younger patients (97.18%).
Conclusions:
- Percutaneous coronary angioplasty (PTCA) is a feasible and effective reperfusion strategy for elderly STEMI patients in Alsace.
- Regional factors, including accessible emergency services and a primary PTCA strategy, support its use in this population.
- PTCA offers comparable revascularization success in elderly STEMI patients, highlighting its importance in geriatric cardiology care.
Objectives:
This prospective multicenter study assessed the prevalence and feasibility of percutaneous coronary angioplasty (PTCA) in the acute phase of ST-elevation myocardial infarction (STEMI) in 3 nonacademic interventional cardiology centers (Alsace, France).
Methods:
We studied the clinical characteristics, angiographic data, and PCTA results of all STEMI patients and analyzed the revascularization rates and adverse events during hospitalization. We compared patients at least 75 years of age and younger patients for these data and with the literature.
Results:
Of the 1672 patients admitted for STEMI, 342 (20.45%) were at least 75 years of age. Half the patients in this high-risk subgroup were women. These patients had more co-morbidities (e.g., hypertension and diabetes mellitus) than younger patients, and more of them had three-vessel disease. Mortality rate was high in this subgroup and always higher than for comparable younger subjects, but it varied according to the initial clinical profile. Their global mortality rate was 20.47%, but it fell to 5.41% when we excluded patients with cardiogenic shock or in Killip stage ill, and those who were resuscitated. PTCA is a coronary reperfusion technique especially indicated for elderly patients with STEMI. It is an effective revascularization technique, with a reperfusion rate (exclusively TIMI III flow) reaching 93.88% in the elderly group, only slightly lower than among younger patients (97.18%).
Conclusion:
PTCA is a technique particularly indicated in the elderly in Alsace because of regional geographic and medical specificities: nearby emergency services are available to virtually the entire population of Alsace, and most interventional cardiology teams apply a strategy of exclusive primary PTCA.
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