Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials)

DeGeare, Vincent S; Stone, Gregg W.; Grines, Lorelei; Brodie, Bruce R.; Cox, David A.; Garcı́a, Eulogio; Wharton, Thomas P.; Boura, Judith; O’Neill, William W.; Grines, Cindy L.

doi:10.1016/s0002-9149(00)00824-9

Cited by 135 publications

(93 citation statements)

References 26 publications

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“…We found that patients with RI were more often elderly and female, presented later, and were more likely to have a reduced left ventricular ejection fraction, all features that have been associated with increased mortality after primary PCI for AMI. 14,18,19 Patients with RI presented with more diffuse atherosclerosis, as evidenced by more frequent peripheral vascular and cerebrovascular disease and triple-vessel coronary artery disease. Patients with RI were also less likely to be discharged on ␤-blockers, which may have contributed to reduced survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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“…Both female sex and old age have been related to worse prognosis after acute myocardial infarction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] As regards gender, various data suggest that it is not an independent adverse prognosticator, but that it is frequently related to high-risk profile and worse coronary angiographic pattern. 13,14 On the other hand, the reasons why elderly patients have a worse prognosis even after successful reperfusion are not completely clear, and apparently neither larger infarct size nor lower LVEF are involved as causative mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The use of primary percutaneous coronary intervention (PCI) has improved the prognosis in elderly patients, but age remains an unfavorable predictor also in this setting. [4][5][6][7][8][9] The mechanisms through which age influences the prognosis are still uncertain. Risk factor profile, angiographic variables and the rate of PCI success do not completely explain the worse prognosis of older patients.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the influence of age and gender on the relationships between infarct size, infarct severity, and left ventricular ejection fraction in patients successfully treated with primary percutaneous coronary intervention

Sciagrà

Parodi

Migliorini

et al. 2010

Journal of Nuclear Cardiology

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Background. Female sex and advanced age have adverse prognostic meaning in acute myocardial infarction. Whether gender and/or age influence the relationship between infarct size, infarct severity, and left ventricular ejection fraction (LVEF) is unclear.Methods. We examined 460 patients (359 men) with acute myocardial infarction submitted to successful primary percutaneous coronary intervention. Infarct size, infarct severity, and LVEF were evaluated with perfusion gated SPECT at one month of index infarction.Results. There were no significant correlations between age and infarct size or infarct severity, and between age and LVEF. Moreover, elderly age ( ‡75 years) did not influence the relationship between LVEF and infarct size or infarct severity. Conversely, there was a significant gender-related difference in the relationship between LVEF and infarct size (F 5 20.5, P < .00001), and between LVEF and infarct severity (F 5 8.6, P < .005). In practice, there was a steeper decrease in LVEF in case of moderate to large infarct size in women than in men.Conclusion. With increasing infarct size, LVEF decreases more sharply in women than in men. Conversely, age does not influence the relationship between infarct dimensions and LVEF. (J Nucl Cardiol 2010)

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“…[1][2][3][4] However, the mechanism by which increasing age contributes to mortality remains unknown. In addition, the therapeutic strategies for elderly patients have not been well established.…”

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confidence: 99%

In-hospital Outcome in Octogenarians with Acute Coronary Syndrome Undergoing Emergent Coronary Angiography.

Shimizu

Ino

et al. 2003

Jpn Heart J

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SUMMARYVery elderly patients have higher mortality rates than younger patients after acute coronary syndrome (ACS). However, the mechanism by which increasing age contributes to such mortality remains unclear. In addition, the efficacy and safety of invasive coronary procedures for octogenarians with ACS have not been well established.We compared the clinical characteristics and in-hospital outcome of 193 octogenarians (mean age, 83 years) with those of 1,462 younger patients (mean age, 64 years) with ACS who underwent emergent coronary angiography. Octogenarians included a greater number of females, had higher rates of cerebrovascular disease and multivessel disease, a higher Killip class, a higher Forrester class, and lower rates of smoking, diabetes, and hypercholesterolemia than the younger subjects. Interventions, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), were performed less frequently in octogenarians than in younger patients (88.0% versus 90.8%). The procedural success rate in octogenarians did not differ from that in younger patients. However, the in-hospital mortality rate for the octogenarians was about three times higher than for the younger patients (19.2% versus 6.9%). Multivariate analysis revealed that the predictors of in-hospital mortality in the octogenarians were a higher Killip class and a higher Forrester class.Octogenarians with ACS had fewer coronary risk factors and a similar success rate for the intervention, but had more greatly impaired hemodynamics and higher in-hospital mortality than the younger patients. Therefore, impaired myocardial reserve may contribute to a large portion of in-hospital deaths in octogenarians with ACS. (Jpn Heart J 2003; 44: 11-20)

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Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials)

Cited by 135 publications

References 26 publications

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Evaluation of the influence of age and gender on the relationships between infarct size, infarct severity, and left ventricular ejection fraction in patients successfully treated with primary percutaneous coronary intervention

In-hospital Outcome in Octogenarians with Acute Coronary Syndrome Undergoing Emergent Coronary Angiography.

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