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21 December 2009

Characteristics and prognosis of coronary revascularization procedure in patients age 80 and older presenting with acute myocardial infarction

Nicolas MansencalACDEF, Remy PilliereABCDG, Roland N’GuettaBC, Alain BeauchetCD, Pascal LacombeDE, Olivier DubourgADEF

Med Sci Monit 2010; 16(1): CR15-20 :: ID: 878310

Abstract

Background
Elderly patients are underrepresented in randomized trials evaluating strategies of early coronary revascularization in acute myocardial infarction (MI), whereas in real life octogenarians represent the fastest-growing segment of our population. We sought to describe the characteristics and outcome of patients > or = 80 years referred to a catheterization laboratory for MI.
Material and Method
We studied 1687 consecutive patients referred to our cath-laboratory for MI, divided into 2 groups: group 1 patients aged > or =80 years (n=152) and group 2 (<80 years, [n=1535]). Baseline clinical and angiographic characteristics and mortality were studied.
Results
Cardiogenic shock and three-vessel disease were more frequent in the patients > or =80 years (p<0.0001). Angiographic success of percutaneous coronary interventions was high in elderly patients (89.5%), but was significantly lower as compared to group 2 (p<0.0001). In-hospital mortality was 18% in group 1 versus 5.5% in group 2 (p<0.0001). No patient from group 1 presenting anterior MI with cardiogenic shock survived. The rate of mortality in group 1 between the end of hospitalization and one year following MI was only 4% (versus 3% in group 2, p=0.58). Long-term prognosis of elderly patients was similar as compared to expected survival of subjects > or =80 years.
Conclusions
This study demonstrates that the angiographic characteristics of patients > or =80 years are significantly different, associated with an initial increased risk of mortality, and that prognosis of MI is excellent once the acute phase has passed.

Keywords: Prognosis, Myocardial Revascularization - methods, Myocardial Infarction - surgery, Kaplan-Meier Estimate, Aged, 80 and over, Shock, Cardiogenic - etiology

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750