Outcomes and Predictors of Mortality Among Octogenarians and Older With ST‐Segment Elevation Myocardial Infarction Treated With Primary Coronary Angioplasty

Abstract

Background: Elderly patients are at high risk of mortality when they present with ST-elevation myocardial infarction (STEMI). However, few data exist about prognostic factors in this sub-group when treated with primary percutaneous coronary intervention (pPCI). Hypothesis: To assess outcome and predictors of mortality among patients aged >80 years treated with pPCI. Methods: We evaluated 139 consecutive patients (age 85.1 ± 3.9 years, 43.2% males) who underwent pPCI for STEMI. Results: Male patients were younger and were more likely to have a history of coronary artery disease. Overall 30-day and 1-year mortality rates were 20.9% and 28.1%, respectively. Thrombolysis in Myocardial Infarction (TIMI) flow 3 was achieved in 82% of patients. There was a pPCI success rate in male patients. At univariable analysis, older age, diabetes mellitus, Killip class >III, left ventricular ejection fraction (LVEF) <40%, no use of stent, failure of pPCI, systolic blood pressure (SBP) <100 mm Hg, and infarct-related artery (left anterior descending vs others) were associated with higher 1-year mortality. Multivariate analysis identified LVEF <40% (hazard ratio: [HR] = 3.70; 95% confidence interval [CI]: 1.30-7.87; P = 0.0001), age (1-year step, HR: 1.13; 95% CI: 1.04-1.23; P = 0.007), failure of pPCI (HR: 2.93; 95% CI: 1.44-5.98; P = 0.0001), Killip class ≥III (HR: 2.29; 95% CI: 1.03-5.4; P = 0.04) and SBP <100 mm Hg (HR: 2.64; 95% CI: 1.22-5.19; P = 0.01) to be independently associated with increased 1-year mortality. Conclusions: Our data show that elderly patients with STEMI have a high risk of mortality, which is particularly high in the first 30 days. Older age, LVEF <40% at admission, hemodynamic instability (higher Killip class or low SBP), and postinterventional TIMI flow <3 were independent predictors of mortality in our population.

Predictors of in‐hospital mortality in octogenarian patients who underwent primary percutaneous coronary intervention after ST segment elevated myocardial infarction

“…showed that female age ≥85 years, female sex, anterior MI, cardiogenic shock and unsuccessful reperfusion were the predictors of mortality in 30 days . Consistently, older age, heart failure and shock were shown as independent predictors of mortality in 30 days after STEMI …”

“…Advances in mortality and morbidity with invasive therapy were clearly shown in this population . Predictors of long‐term mortality in octogenarian patients, who has undergone primary PCI after acute STEMI, were studied in some other studies . However, risk factors for in‐hospital mortality were underrepresented.…”

“…15,16 Predictors of long-term mortality in octogenarian patients, who has undergone primary PCI after acute STEMI, were studied in some other studies. 7,8,[17][18][19] However, risk factors for in-hospital mortality were underrepresented. Furthermore, data regarding the risk factors were not consistent as a result of the wide range of designs and inclusion criteria of the studies.…”

Percutaneous coronary intervention in the elderly: current updates and trends

“…Beside age of the patient, many other variables have been proven to be an independent predictor of unfavorable outcome in the elderly undergoing PCI. Reduced cardiac function with left ventricular ejection fraction (LVEF) lower than 40%, Killip class of 3 or worse, cardiogenic shock, and hypotension with systolic blood pressure (SBP) lower than 100 mmHg have all been identified as independent predictors of an increased risk of 1-year mortality [43] . Also, the activity of daily living (ADL) of old age patients after PCI can be used to predict mortality.…”

“…As it was discussed above, the coronary lesions in the elderly tend to be more complex and extensive which may render them suitable only for plain old balloon angioplasty (POBA) due to a failure of stent delivery, or inability to stent lesions in distal or small diameter vessels [43] . On the other hand, stenting technology has revolutionized during the last era.…”