Long-Term Clinical Outcomes after Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction Older than 75 Years

Abstract

Background and Objectives：Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term follow-up, compared with thrombolytic therapy for acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients. Subjects and Methods：Two hundred and twenty three patients (Group I: n=66, age≥75 years, Group II: n=157, age<75 years), who underwent primary PCI for AMI at Chonnam National University Hospital, between 2000 and 2002, were analyzed according to their clinical, angiographic characteristics, inhospital and one-year survival. Results：Group I had a higher percentage of women (45.5% vs. 19.1%, p= 0.00), multi-vessel disease (42% vs. 28%, p=0.031), right coronary artery disease (52% vs. 33%, p=0.021), and more frequent histories of diabetes mellitus (35% vs. 22%, p=0.039) and less smoking (38% vs. 60%, p= 0.003) than Group II. Successful reperfusion by PCI was achieved in 97 and 96 %, respectively (p=NS). The rates of in-hospital mortality were similar in both groups (12.1% vs. 8.2%, p=NS). There were no significant differences in the major adverse cardiac events between the two groups during the one-year clinical p=NS). Conclusion：Primary PCI in AMI patients older than 75 years can be performed with comparable procedural success rates and long-term clinical outcomes to those of younger patients. (Korean Circulation J 2005;35:613-619) KEY WORDS：Elderly；Myocardial infarction；Angioplasty. 서 론 최근에 급성 심근경색증 환자에서 혈전용해제보다 일차적 경피적 관상동맥 중재술(PCI: percutaneous coronary intervention)이 단기적 및 장기적 임상 효과가 좋음이 보고 되고 있으며, 1-4) 2004년 American College of Cardiology/ 논문접수일：2005년 3월 02일 심사완료일：2005년 5월 23일 교신저자：정명호, 501-757 광주광역시 동구 학1동 8번지 전남대학교 의과대학 전남대학교병원 심장센터, 의과학연구소 전화：(062) 220-6243·전송：(062) 228-7174·E-mail：myungho@chol.com

Successful Percutaneous Coronary Intervention in a Centenarian Patient With Acute Myocardial Infarction

“…The long-term outcome of PCI in the elderly is still controversial. In clinical practice, the elderly are more likely to undergo conservative medical therapy rather than PCI 10-12). For centenarians, this is especially true 2).…”

“…In clinical practice, the elderly are more likely to undergo conservative medical therapy rather than PCI. 10 - 12) For centenarians, this is especially true. 2) However, advancements in technology, procedural techniques, and adjunctive medical therapies are constantly improving procedural success rate and clinical outcome.…”