Influence of age on long-term outcome after emergent percutaneous coronary intervention for ST-elevation myocardial
Chin Hiew1, Trent Williams, Rachael Hatton
1Cardiovascular Unit, John Hunter Hospital, Newcastle, New South Wales, Australia.
Insights
Age alone does not predict adverse outcomes in elderly patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Instead, comorbidities and procedural factors influence outcomes, guiding future treatment strategies for this demographic.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Percutaneous coronary intervention (PCI) is preferred over thrombolysis for ST-elevation myocardial infarction (STEMI).
- Elderly patients with STEMI face higher in-hospital mortality.
- Predictors of adverse outcomes and late follow-up data in elderly STEMI patients are limited.
Purpose of the Study:
- To evaluate early and late outcomes of emergent PCI for STEMI in all patients.
- To identify predictors of late adverse events after PCI for STEMI.
- To determine if advanced age alone predicts adverse outcomes in STEMI patients undergoing PCI.
Main Methods:
- Retrospective review of patients undergoing emergent PCI for STEMI.
- Inclusion of patients who had primary PCI or rescue PCI for failed thrombolysis.
- Data collected from December 2003 to December 2007 at a single tertiary referral center.
Main Results:
- 269 patients underwent primary or rescue PCI for STEMI.
- Patients aged 70 years or older had more cardiovascular risk factors and coronary artery disease.
- Thrombolysis in Myocardial Infarction (TIMI) 3 flow predicted good outcomes; recurrent in-hospital ischemia, prior aspirin use, and discharge creatinine predicted poor outcomes. Age was not an independent predictor of adverse outcomes.
Conclusions:
- Increased mortality in elderly STEMI patients undergoing PCI is linked to comorbidities and procedural issues, not age itself.
- Future strategies should focus on identifying elderly STEMI patients who will benefit most from invasive procedures.
- Optimizing STEMI management in the elderly requires a nuanced approach beyond chronological age.
Background:
Percutaneous coronary intervention (PCI) provides advantages compared to thrombolytic therapy in the treatment of ST-elevation myocardial infarction (STEMI). Elderly patients have increased in-hospital mortality; the predictors of adverse outcomes are not well established, with limited data available regarding late follow up of these patients. We evaluated early and late outcomes of patients undergoing emergent PCI for STEMI to identify the predictors of subsequent late adverse events and, in particular, determine if age alone was a predictor of an adverse outcome.
Materials And Methods:
A retrospective review of all patients referred for emergent PCI for STEMI to a single tertiary referral center was performed. All patients undergoing primary PCI for STEMI or rescue PCI for failed thrombolysis between December 2003 and December 2007 were included for assessment.
Results:
During the study period, 269 patients underwent primary or rescue PCI for STEMI. Patients > or = 70 years of age were more likely to have established cardiovascular risk factors and documented coronary artery disease. Thrombolysis in myocardial infarction (TIMI) 3 flow predicted a good outcome, whereas recurrent ischemia in hospital, prior aspirin therapy and discharge creatinine predicted a poor outcome; age alone was not an adverse prognostic factor.
Conclusions:
The increased mortality in elderly patients undergoing PCI for STEMI reflects comorbidity and suboptimal procedural outcomes rather than any age effect per se. Future approaches to optimize the management of STEMI in the elderly should include identification of those patients most likely to benefit from an invasive approach.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism