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Published on: December 2, 2014
Left ventricular remodeling in the elderly with acute anterior myocardial infarction treated with primary coronary
Francesca Innocenti1, Francesca Caldi, Cinzia Meini
1Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 1, 50141, Florence, Italy. innocentif@aou-careggi.toscana.it
Insights
Primary percutaneous coronary intervention (pPCI) effectively manages acute anterior ST-elevation myocardial infarction (aSTEMI) in older adults, showing similar left ventricular remodeling and function compared to younger patients. This highlights PCI
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Acute anterior ST-elevation myocardial infarction (aSTEMI) significantly impacts left ventricular (LV) remodeling and function.
- Primary percutaneous coronary intervention (pPCI) is the standard treatment for aSTEMI.
- Understanding age-related differences in post-aSTEMI LV remodeling is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare left ventricular (LV) remodeling and function after primary percutaneous coronary intervention (pPCI) for acute anterior ST-elevation myocardial infarction (aSTEMI) in different age groups.
- To assess the impact of age on the effectiveness of pPCI in preserving LV structure and function post-aSTEMI.
Main Methods:
- A cohort of 116 patients surviving a first-time aSTEMI treated with pPCI was divided into two age groups (<65 and ≥65 years).
- Dobutamine stress-echocardiography (DSE) was performed to assess LV wall motion and function.
- Non-invasive measurement of left anterior descending coronary artery flow reserve (CFR) was conducted using intravenous adenosine infusion.
Main Results:
- Baseline LV dimensions and systolic function were similar between younger and older patient groups.
- Wall motion score indices during DSE and CFR were comparable across age groups.
- LV ejection fraction was positively influenced by myocardial viability and higher CFR, and negatively by remote viability (indicating larger infarct size) in both groups.
Conclusions:
- Primary percutaneous coronary intervention (pPCI) for acute anterior ST-elevation myocardial infarction (aSTEMI) yields comparable left ventricular (LV) remodeling and functional outcomes in geriatric and younger populations.
- Age is not a limiting factor for the efficacy of pPCI in managing aSTEMI regarding LV recovery.
- The findings support the use of pPCI in older adults with aSTEMI, ensuring similar benefits in LV preservation as observed in younger individuals.
Abstract:
We compared left ventricular (LV) remodeling following a first time acute anterior ST-elevation myocardial infarction (aSTEMI) treated with primary coronary intervention (pPCI) in different age groups. A total of 116 patients, 61 aged <65 and 55 aged >or=65 years, who survived after a recent aSTEMI treated with pPCI, underwent dobutamine stress-echocardiography (DSE) and non-invasive measurement of left anterior descending coronary artery flow reserve (CFR) during intravenous adenosine infusion. Baseline LV dimensions and systolic function were similar between the two groups; wall motion score indices during all DSE stages and CFR were also similar. In both groups, the LV ejection fraction was positively affected by the presence of viability in the necrosis area and by a higher CFR, but negatively influenced by viability in a remote area, an indirect sign of an extensive infarction size. This study demonstrates that PCI in the geriatric population with aSTEMI is as equally effective as in younger subjects, in terms of LV remodeling and function.
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