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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Outcome of elderly patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial
Peter Wenaweser1, Marianne Ramser, Stephan Windecker
1Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Insights
Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in elderly patients (>/=75 years) shows favorable outcomes. While procedural success was lower in older adults, major adverse cardiac events were comparable to younger patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- ST-elevation myocardial infarction (STEMI) is a critical condition requiring prompt treatment.
- Elderly patients often present with comorbidities, influencing treatment outcomes.
- Percutaneous coronary intervention (PCI) is a primary treatment for STEMI.
Purpose of the Study:
- To evaluate the effectiveness and safety of primary PCI in elderly patients (>/=75 years) with STEMI.
- To compare outcomes of primary PCI in elderly versus younger STEMI patients.
Main Methods:
- Prospective enrollment of 319 STEMI patients within 6-12 hours of symptom onset.
- Comparison of 40 elderly patients (>/=75 years) undergoing primary PCI with 256 younger patients.
- Assessment of PCI success rates, door-to-balloon times, periprocedural complications, and 6-month major adverse cardiac events.
Main Results:
- Elderly patients had lower ejection fraction and more cardiovascular risk factors.
- PCI success rates were 80% in elderly vs. 91% in younger patients (P=0.031).
- Door-to-balloon times were comparable; periprocedural complications were low in both groups.
Conclusions:
- Primary PCI in elderly STEMI patients yields favorable clinical outcomes, comparable to younger populations.
- While procedural success is lower in the elderly, the intervention is safe with no increased periprocedural complications.
- PCI should be considered for elderly patients with acute STEMI.
Aim:
To investigate the outcome of primary percutaneous coronary interventions (PCI) in elderly patients (>/=>/=75 years) with ST-elevation myocardial infarction (STEMI).
Methods And Results:
Between 1995 and 2003, a total of 319 consecutive patients with acute ST-elevation myocardial infarction presenting within 6-12 hr after onset of symptoms were prospectively enrolled in a registry. Of 296 patients undergoing primary PCI, 40 patients were >/=>/=75 years old (group A) and 256 patients younger than 75 years (group B). Elderly patients presented with a lower ejection fraction (49 +/- 14% vs. 53 +/- 13%, P = 0.046) and a higher number of cardiovascular risk factors. PCI success was achieved in 80% (group A) and 91% (group B, P = 0.031), respectively with comparable door-to-balloon times (87 +/- 49 and 95 +/- 79 min, P = ns). Periprocedural complications in both groups were low and major adverse cardiac events (death, myocardial infarction, target vessel revascularization and cardiac rehospitalization) after 6 months amounted to 23% (group A) and 20% (group B, P = ns), respectively.
Conclusions:
Clinical outcome of elderly patients (>/=>/=75 years) with acute STEMI is favorable and comparable with the middle-aged population. However, procedural success was significantly lower in elderly (80%) compared to younger patients (90%). Acute percutaneous coronary intervention appears to be safe and not associated with higher periprocedural complications, in elderly patients.
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