Early Invasive Strategy for Octogenarians and Nonagenarians With Acute Myocardial Infarction
Junya Komatsu1, Yu-Ki Nishimura1, Hiroki Sugane1
1Department of Cardiology, Chikamori Hospital Kochi Japan.
Insights
Older adults (≥80) with acute myocardial infarction (AMI) face higher mortality and adverse events. However, early invasive strategies like primary percutaneous coronary intervention (PCI) show improved outcomes, even in frail elderly patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Internal Medicine
Background:
- Older adults represent a growing population experiencing acute myocardial infarction (AMI).
- Clinical presentation and outcomes in this demographic remain incompletely understood.
- Current treatment guidelines for elderly AMI patients require further clarification.
Purpose of the Study:
- To compare clinical characteristics and outcomes of AMI patients aged ≥80 years versus those aged ≤79 years.
- To investigate the impact of frailty on outcomes in elderly AMI patients.
- To evaluate the effectiveness of primary percutaneous coronary intervention (PCI) in octogenarians and nonagenarians.
Main Methods:
- Retrospective analysis of 268 consecutive AMI patients.
- Comparison of clinical characteristics and 1-year outcomes (MACE, all-cause mortality) between the Over-80 and Under-79 groups.
- Multivariate analysis to identify predictors of MACE and mortality in the Over-80 group.
Main Results:
- Primary PCI rates were similar across age groups (86% vs. 89%).
- The Over-80 group exhibited higher Killip class III-IV, in-hospital mortality, MACE, and all-cause mortality.
- Frailty was associated with worse outcomes in the Over-80 group; PCI inversely correlated with mortality in this cohort.
Conclusions:
- Primary PCI rates are maintained in older adults with AMI.
- Octogenarians and nonagenarians present more severely and have worse short-term outcomes, especially if frail.
- An early invasive strategy, including PCI, may improve prognosis in very elderly AMI patients.
Abstract:
Older adults with acute myocardial infarction (AMI) are currently a rapidly growing population. However, their clinical presentation and outcomes remain unresolved. A total of 268 consecutive AMI patients were analyzed for clinical characteristics and outcomes with major adverse cardiovascular events (MACE) and all-cause mortality within 1 year. Patients aged ≥80 years (Over-80; n=100) were compared with those aged ≤79 years (Under-79; n=168). (1) Primary percutaneous coronary intervention (PCI) was frequently and similarly performed in both the Over-80 group and the Under-79 group (86% vs. 89%; P=0.52). (2) Killip class III-IV (P<0.01), in-hospital mortality (P<0.01), MACE (P=0.03) and all-cause mortality (P<0.01) were more prevalent in the Over-80 group than in the Under-79 group. (3) In the Over-80 group, frail patients showed a significantly worse clinical outcome compared with non-frail patients. (4) Multivariate analysis revealed Killip class III-IV was associated with MACE (odds ratio [OR]=3.51; P=0.02) and all-cause mortality (OR=9.49; P<0.01) in the Over-80 group. PCI was inversely associated with all-cause mortality (OR=0.13; P=0.02) in the Over-80 group. The rate of primary PCI did not decline with age. Although octogenarians/nonagenarians showed more severe clinical presentation and worse short-term outcomes compared with younger patients, particularly in those with frailty, the prognosis may be improved by early invasive strategy even in these very old patients.
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