Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes
Jacek Piegza1, Lech Poloński1, Aneta Desperak1
1Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Insights
Treatment for myocardial infarction (MI) in patients over 100 years old showed invasive strategies may improve 12-month outcomes. Lower ejection fraction, lack of angiography, and cardiac arrest predicted mortality in this elderly group.
Area of Science:
- Cardiology
- Geriatric Medicine
- Acute Coronary Syndromes
Background:
- Limited data exists on mortality, risks, and benefits of reperfusion methods and pharmacological treatments for acute coronary syndromes in patients over 100 years old.
- Assessing myocardial infarction (MI) treatment and prognostic factors in this specific elderly population is crucial.
Purpose of the Study:
- To evaluate the treatment strategies for myocardial infarction (MI) in patients aged 100 years and older.
- To identify prognostic factors influencing outcomes in this unique demographic.
Main Methods:
- A retrospective analysis of 104 patients (≥100 years) with MI from the Polish Registry of Acute Coronary Syndromes (2003-2018).
- Patients were divided into two groups: conservative treatment (64 patients) and invasive strategy (40 patients).
Main Results:
- In-hospital mortality, MI, and stroke rates were similar between conservative and invasive groups.
- The invasive strategy demonstrated a significant benefit in 12-month outcomes, with lower mortality (57.5% vs. 79%).
- Predictors of 12-month mortality included lower left ventricular ejection fraction, absence of coronary angiography, and cardiac arrest.
Conclusions:
- Invasive treatment for MI may offer advantages for carefully selected very elderly patients.
- Prognostic factors like ejection fraction and cardiac arrest status are critical for long-term survival in this age group.
Background:
There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group.
Methods:
Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients).
Results:
The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94-0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24-0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64-12.99; p = 0.0038) as predictors of 12-month mortality in this group.
Conclusions:
Invasive MI treatment may be beneficial for selected very old patients.
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