Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction – A cardiac magnetic resonance imaging study

Abstract

Background Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort. Methods Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years. Results Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001). Conclusion Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.

Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients

“…Not only an adverse prognostic factor in itself, age is also associated with other undesirable events such as longer delay between symptoms onset and therapeutic intervention, greater incidence of renal failure, worse Killip class and increased comorbidities [5][6][7]. Even if appropriate revascularization by percutaneous coronary intervention is performed, older STEMI patients have 4-fold increased risk of death or re-hospitalisation for heart failure (HF) after the acute event [1,8].…”

MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure

“…Despite their increased risk of adverse events after STEMI, 4–6 elderly patients have traditionally been underrepresented in observational studies and clinical trials. Nonetheless, recent studies have focused on risk prediction in this population by clinical and MRI‐derived parameters 37,38 .…”

“…3 Besides often presenting with atypical ischemic symptoms and altered baseline ECG that complicates STEMI identification, elderly patients also have a 4-fold increased risk of death or rehospitalization for acute heart failure (AHF). 4,5 Moreover, age-related factors such as comorbidities and geriatric syndromes further aggravate the prognosis of STEMI patients. 6,7 AHF is one of the most frequent complications after STEMI 8 and substantially worsens long-term prognosis in contemporary registries.…”

“…Nowadays, patients over 75 years represent more than a third of the STEMI population 3 . Besides often presenting with atypical ischemic symptoms and altered baseline ECG that complicates STEMI identification, elderly patients also have a 4‐fold increased risk of death or rehospitalization for acute heart failure (AHF) 4,5 . Moreover, age‐related factors such as comorbidities and geriatric syndromes further aggravate the prognosis of STEMI patients 6,7 …”

Cardiac magnetic resonance shows increased adverse ventricular remodeling in younger patients after ST-segment elevation myocardial infarction

“…However, in the contemporary era of PPCI and intensive medical therapy, few studies compared the differences in ventricular remodeling between young and old patients. Using CMR with more accurate myocardial evaluation, there was no substantial difference in baseline infarct size, AAR, MSI and MVO (myocardial injury) between young and older patients with STEMI [ 4 , 18 ]. Our findings are consistent with those data.…”