The Role of Invasive Therapies in Elderly Patients with Acute Myocardial Infarction

Nicolau, José Carlos; Lemos, Pedro A.; Wajngarten, Maurı́cio; Giraldez, Roberto R.; Serrano, Carlos; Martinez, Eulógio E.; Baracioli, Luciano Moreira; Kalil, Roberto; Jatene, Fábio Biscegli; Dallan, Luís Alberto Oliveira; Puig, Luis B.; Na, Stolf

doi:10.1590/s1807-59322009000600010

Cited by 12 publications

(9 citation statements)

References 27 publications

(28 reference statements)

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“…Since age is a factor that cannot be changed, we have to focus on improvement of other modalities that can be influenced, such as shortening of the times between symptom onset and primary PCI [ 15 ]. Our findings strongly support the use of PCI in all patients (HR 0.60, p = 0.008 in younger patients and HR 0.46; p < 0.001 in older patients), which was also demonstrated by Nicolau et al [ 16 ] in the ≥ 70 years population in adjusted models (HR 0.64, p = 0.001 older patients vs. HR 0.74, p = 0.073 younger patients).…”

Section: Discussionsupporting

confidence: 91%

Age – related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era

Kala

Kaňovský

Rokyta

et al. 2012

BMC Cardiovasc Disord

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BackgroundOlder age, as a factor we cannot affect, is consistently one of the main negative prognostic values in patients with acute myocardial infarction. One of the most powerful factors that improves outcomes in patients with acute coronary syndromes is the revascularization preferably performed by percutaneous coronary intervention. No data is currently available for the role of age in large groups of consecutive patients with PCI as the nearly sole method of revascularization in AMI patients. The aim of this study was to analyze age-related differences in treatment strategies, results of PCI procedures and both in-hospital and long-term outcomes of consecutive patients with acute myocardial infarction.MethodsRetrospective multicenter analysis of 3814 consecutive acute myocardial infarction patients divided into two groups according to age (1800 patients ≤ 65 years and 2014 patients > 65 years). Significantly more older patients had a history of diabetes mellitus and previous myocardial infarctions.ResultsThe older population had a significantly lower rate of coronary angiographies (1726; 95.9% vs. 1860; 92.4%, p < 0.0001), PCI (1541; 85.6% vs. 1505; 74.7%, p < 0.001), achievement of optimal final TIMI flow 3 (1434; 79.7% vs. 1343; 66.7%, p < 0.001) and higher rate of unsuccessful reperfusion with final TIMI flow 0-1 (46; 2.6% vs. 78; 3.9%, p = 0.022). A total of 217 patients (5.7%) died during hospitalization, significantly more often in the older population (46; 2.6% vs. 171; 8.5%, p < 0.001). The long-term mortality (data for 2847 patients from 2 centers) was higher in the older population as well (5 years survival: 86.1% vs. 59.8%). Though not significantly different and in contrast with PCI, the presence of diabetes mellitus, previous MI, final TIMI flow and LAD, as the infarct-related artery, had relatively lower impact on the older patients. Severe heart failure on admission (Killip III-IV) was associated with the worst prognosis in the whole group of patients, though its significance was higher in the youngers (HR 6.04 vs. 3.14, p = 0.051 for Killip III and 12.24 vs. 5.65, p = 0.030 for Killip IV). We clearly demonstrated age as a strong discriminator for the whole population of AMI patients.ConclusionsIn a consecutive AMI population, the older group (>65 years) was associated with a less pronounced impact of risk factors on long-term outcome. To ascertain the coronary anatomy by coronary angiography and proceed to PCI if suitable regardless of age is crucial in all patients, though the primary success rate of PCI in the older age is lower. Age, when viewed as a risk factor, was a dominant discriminating factor in all patients.

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Section: Discussionsupporting

confidence: 91%

Age – related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era

Kala

Kaňovský

Rokyta

et al. 2012

BMC Cardiovasc Disord

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“…Analysis of previous studies shows that a sequence of patient characteristics, including advanced age, female sex, lower ejection fraction, comorbid conditions, urgency of operation, and reoperation, may be linked to increased operative risk 6,18,24-32. In the present study, both late overall and late cardiac mortality were associated with lower ejection fraction, fewer bypass grafts, and longer duration of cardiopulmonary bypass.…”

Section: Discussionsupporting

confidence: 53%

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy

Serrano

Ramires

Soeiro

et al. 2010

Clinics

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INTRODUCTION:The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes.METHODS AND MATERIAL:Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95% of the patients.RESULTS:Cumulative in‐hospital and 36‐month mortalities were 7% and 15%, respectively. These respective rates varied according to preoperative parameters: CHF class I‐II, 4% and 13%; CHF class III‐IV, 8% and 16%; LVEF<20%, 12% and 26%; LVEF 21‐30%, 2% and 6%; gated LVEF exercise/rest >5%, <1% and 4%; and gated LVEF exercise/rest ≤5%, 17% and 38%. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow‐up based on the results of a multivariate analysis. After three years of follow‐up, 84% of the patients were in class I/II, LVEF was 45±7%, and gated LVEF ex/rest ratio was 13% higher (p<0.01) compared to the beginning of the study.CONCLUSIONS:These data suggest that aneurysmectomy among patients with severe LV dysfunction result in short‐ and long‐term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients.

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“…En pacientes que se presentan en las tres primeras horas de aparición de los síntomas, se recomienda un tiempo puerta-balón-puerta-aguja de menos de 60 minutos. [26] Universidad de Manizales -Facultad de Ciencias de la Salud…”

Section: Terapia De Reperfusiónunclassified

Síndrome coronario agudo en el anciano: evaluación, diagnóstico y tratamiento.

Isaza¹,

Cano²

2017

archmed

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Introducción: La enfermedad coronaria, y en especial los síndromes coronarios agudos, son un grupo de entidades que generan alta mortalidad en la población anciana, que a su vez, representa un grupo poblacional importante en las diversas series epidemiológicas, caracterizándose por sus dificultades diagnósticas y terapéuticas, caracterizadas por una pobre cantidad de estudios y una baja representatividad en los ensayos clínicos, generando grandes dudas en la práctica clínica diaria. Objetivo: describir los aspectos más actualizados y relevantes en síndrome coronario agudo en el anciano, haciendo énfasis en el proceso diagnóstico y sus variaciones, y las consideraciones terapéuticas basadas en la última evidencia científica disponible. Metodología: se realizó una revisión sistemática de la literatura sobre síndrome coronario agudo en el anciano publicado en los últimos 20 años, desde 1996 hasta 2016, en las bases de datos PubMed, y Embase durante los meses de diciembre de 2015 y enero de 2016. Se incluyeron artículos en idioma inglés y español. La exclusión de los estudios se hizo con base a la evaluación de los resúmenes. Conclusión: Los ancianos son un grupo poblacional altamente heterogéneo, presentando múltiples cambios fisiológicos carviovasculares, generando grandes variaciones en la clínica del síndrome coronario agudo. Su representación en los diferentes ensayos clínicos sigue siendo pobre, lo que dificulta la toma de decisiones en la práctica clínica. Se requieren más estudios para precisar el manejo más óptimo en el anciano.

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The Role of Invasive Therapies in Elderly Patients with Acute Myocardial Infarction

Cited by 12 publications

References 27 publications

Age – related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era

Age – related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy

Síndrome coronario agudo en el anciano: evaluación, diagnóstico y tratamiento.

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