Effectiveness and Safety of Routine Primary Angioplasty in Patients Aged .GEQ.85 Years With Acute Myocardial Infarction

Valente, Serafina; Lazzeri, Chiara; Salvadori, Claudia; Chiostri, Marco; Giglioli, Cristina; Poli, Serena; Gensini, Gian Franco

doi:10.1253/circj.72.67

Cited by 48 publications

(44 citation statements)

References 11 publications

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“…22,23 In our study, very old STEMI patients also showed more marked inflammatory activation (as inferred by ESR and fibrinogen values), which may contribute to the increased glucose values; it is interesting to note that the infarct size (as inferred by Tn I values) was not significantly different among age groups. We further confirm that elderly STEMI patients show an increase inhospital mortality, 8,24 as well as increased values of NT-pro BNP. 25 It cannot be ruled out that the elevation of ESR in the older patients might be related to a possible higher prevalence of anaemia in these patients, which agrees with the observed decrease in the renal function.…”

Section: Discussionsupporting

confidence: 82%

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Lazzeri

Valente

Chiostri

et al. 2010

Diabetes and Vascular Disease Research

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In elderly patients with AMI, hyperglycaemia is associated with increased mortality. Recently it has been observed that insulin resistance, as assessed by the HOMA index, proved an independent predictor of in-hospital mortality. The interaction between age and glucose metabolism response in the acute phase of patients with STEMI without previously known diabetes has not yet been explored. We aimed to assess this relationship in 346 consecutive patients with STEMI admitted to our ICCU after primary PCI.When compared with the other age subgroups, the very oldest patients (aged > 79 years) showed the lowest LVEF (p=0.011), the highest incidence of 2-and 3-vessel coronary artery disease (p=0.002), and, finally, the highest mortality (p=0.037). Advancing age was associated with increased values of fibrinogen (p=0.022) and ESR (p=0.001), as well as of NT-pro-BNP (p<0.001). The very oldest patients (aged > 79 years) exhibited the highest values of glycaemia and peak glycaemia, while the incidence of insulin resistance (as inferred by HOMA index) remained unchanged across the age subgroups. This glycaemic pattern was confirmed after exclusion of patients with HbA 1c > 6.5%, that is patients with a poor glycaemic control in the previous 2-3 months.In the acute phase of STEMI acute glucose metabolism is affected by age, since older patients showed the highest glucose levels and the poorest glycaemic control during ICCU stay despite the lack of differences in insulin resistance incidence.

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Section: Discussionsupporting

confidence: 82%

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Lazzeri

Valente

Chiostri

et al. 2010

Diabetes and Vascular Disease Research

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“…This finding is in keeping with earlier clinical trials such as GISSI-2 and GUSTO-1 [9,10] as well as with previous studies in the era of mechanical revascularization by others [11][12][13][14][15][16] and us [17].…”

Section: Introductionsupporting

confidence: 91%

“…In fact, the elderly have a high prevalence of unrecognized and established diabetes [18] and diabetes is more common in the elderly patients with acute myocardial infarction (AMI) in respect to younger patients [17,[19][20][21]. In the Cooperative Cardiovascular Project (CCP), a nationally representative, community-based sample of elderly patients hospitalized with AMI [22], elevated glucose was common, rarely treated and associated with increased mortality, particularly in those without recognized diabetes.…”

Section: Introductionmentioning

confidence: 99%

Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization

Lazzeri

Valente

Chiostri

et al. 2012

International Journal of Cardiology

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Though age is a predictor of adverse events after acute coronary syndrome, including in-hospital and posthospital mortality rates, elderly patients are under-represented in randomized trials evaluating strategies of early coronary revascularization in acute myocardial infarction. Several factors can account for the unfavorable outcome of the elderly, comprising increased glucose values. Diabetes is more common in the elderly patients with acute myocardial infarction in respect to younger patients and elevated glucose, though common, are rarely treated and associated with increased mortality, particularly in those without recognized diabetes. Age itself is thought to affect the acute glucose response to stress. Human aging is associated with impaired β-cell sensitivity to glucose and impaired β-cell compensation to insulin resistance and older people exhibit an impaired glucose response after injury characterized by a more marked increases in endogenous glucose production. In the early phase of ST elevation myocardial infarction (STEMI), the acute glucose response to stress comprises not only hyperglycemia but also insulin-resistance (assessed by the Homeostatic Model Assessment). Recently it has been documented in 346 STEMI patients submitted to mechanical revascularization that the acute glucose response to myocardial injury differs in respect to age, since older patients showed the highest glucose levels and the poorest glycemic control during ICCU stay in the lack of differences in insulin resistance incidence. Taking into account that aging impairs the acute glucose response to stress in elderly STEMI patients, further studies are needed to establish whether a different (more aggressive) therapeutic regime is needed in this subgroup of patients at higher risk.

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“…Antoniucci et al 19 reported 16%, 30-day mortality rates in patients over 80 years old (mean age, 84 years) treated with primary PCI. Valente et al 20 reported a 17% in-hospital mortality rate in STEMI patients over 85 years old (mean age, 88 years) treated with PCI. They also found that age over 90 years as well as Killip class ≥ III on admission and PCI failure were independently correlated with in-hospital mortality.…”

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confidence: 99%

Primary Percutaneous Coronary Interventions in Nonagenarians

Koutouzis

Grip

Matejka

et al. 2010

Clinical Cardiology

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Background:The optimal treatment of very elderly patients with ST elevation myocardial infarction (STEMI) is not yet defined. The aim of this study is to present the feasibility and safety of primary percutaneous coronary interventions (PCI) in nonagenarians.Methods:A retrospective analysis of all patients who underwent primary PCI due to STEMI between 2004 and 2008 was performed. Patients age 90 years or older at the time of the procedure were identified and studied.Results:Twenty‐two patients fulfilled the study criteria (median age 92 years; range, 90–97 years; 50% women). The procedural success rate was 82%. Bare metal stent implantation was performed in 82% of the procedures, whereas only balloon angioplasty was performed on the rest of them. One patient experienced a minor bleeding complication. Procedural mortality was 9% (2 out of 22 patients), and it was due to “no flow” phenomenon in both patients. In‐hospital mortality was 27% (6/22 patients) and 30‐day mortality was 32% (7/22 patients). All 3 patients with Killip class III–IV on admission died within 30 days compared with 4 of the 19 patients with Killip class I–II (P = 0.023). Furthermore, of 11 patients with anterior infarction, 7 died within 30 days compared with none of the 11 patients with infarction of other location (P = 0.004).Conclusions:Although primary PCI is feasible in patients 90 years or older suffering from STEMI, the short‐term mortality rate is high especially in patients with anterior infarct location and/or severely depressed myocardial function. Copyright © 2010 Wiley Periodicals, Inc.

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Effectiveness and Safety of Routine Primary Angioplasty in Patients Aged .GEQ.85 Years With Acute Myocardial Infarction

Cited by 48 publications

References 11 publications

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response

Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization

Primary Percutaneous Coronary Interventions in Nonagenarians

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