Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

Abstract

Objective -Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI.Methods -The patients were divided into three different age groups (60/69, 70/79, and >80 years) Elderly patients are a progressively growing population, composing a high-risk subgroup for the occurrence of acute myocardial infarction (AMI). According to the American Heart Association, in the year 2000, the worldwide population above 70 years olds will be 21.1 millions, and the expectations for 2010, 2020, and 2030 will be of geometric increase, with 27.3, 35.7, and 49.7 million elderly people, respectively. In the last eight years (1990/98), the population greater than 85 years of age, has increased more than 34% 1 . The potential of developing coronary heart disease in this increasing population of elderly people is remarkable. North American demographics from 1996 (American Heart Association Biostatistical Fact Sheets on Older Americans and Cardiovascular Diseases) indicate that 85% of the cardiovascular deaths occurred in patients greater than 65 years of age. In addition to this, 57% of the patients discharged after the occurrence of acute myocardial infarction (AMI), were above 65 years of age.The occurrence of an AMI in patients older than 70, usually promotes higher death rates or other major complications related to this event [1][2][3][4][5] . Currently, thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA) were the methods available for obtaining fast and early myocardial reperfusion 2,6 . However, few patients, less than 20% of the elderly patients with AMI, were selected to receive thrombolytic therapy in the first 24 hours of AMI onset 1 . The higher risk for the occurrence of a cerebral stroke causes caution to be taken with this therapeutic method when treating many elderly patients [7][8][9] . Otherwise, a recent analysis of subgroups of patients included in a large multinational AMI randomized trial did not show an effective reduction in death rates among patients older than 75 treated with thrombolytic therapy 8 . Primary PTCA has many advantages over the administration of thrombolytic therapy 10 . Despite these, many elderly patients eager to be included in this therapeutic per-

Letter to the Editor

“…We read with great interest the paper from Mattos et al 1 reporting that primary percutaneous transluminal coronary angioplasty (PTCA) caused higher clinical adverse events with the increase of death rate, longer delay until successful reperfusion, lower success rate in elderly patients, mainly after 69 years of age, than ages less than 69 underwent. Because of higher mortality rate of thrombolytic theraphy in the elderly population presented with acute myocardial infarction, there has been an increasingly trend toward primary PTCA 2 .…”

“…In the introduction section of the paper, it was reported that the worldwide population over 70-year old was 21.1 millions in the year of 2000 and the estimation would be 27.3, 35.7, and 49.7 in 2010, 2020, and 2030, respectively 1 . But, these numbers are the numbers reported by the American Heart Association (AHA) for the USA, and these expectations are very low for the world without a doubt.…”