Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction

Helft, Gérard; Georges, Jean; Mouranche, Xavier; Loyeau, Aurélie; Spaulding, Christian; Caussin, Christophe; Benamer, Hakim; Garot, Philippe; Livarek, B.; Teiger, Emmanuel; Varenne, Olivier; Monségu, Jacques; Mapouata, Mireille; Petroni, Thibaut; Hammoudi, Nadjib; Lambert, Yves; Dupas, François; Laborne, François-Xavier; Lapostolle, Frédéric; Lefort, Hugues; Juliard, Jean‐Michel; Letarnec, Jean-Yves; Lamhaut, Lionel; Lebail, Gaelle; Boche, Thévy; Jouven, Xavier; Bataille, Sophie

doi:10.1016/j.ijcard.2015.04.227

Cited by 38 publications

(30 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study sought to describe a population of octogenarians and their outcomes after PPCI for STEMI and to compare both short‐ and long‐term clinical outcomes with younger patients. As suspected, we found an association between octogenarian patients and increased procedural complications, in‐hospital major adverse cardiac events, and long‐term all‐cause mortality, which confirms the findings of several recent studies . Similarly, our study confirms that the annual proportion and absolute numbers of octogenarians gradually increased over the study period, making this an increasingly important patient group .…”

Section: Discussionsupporting

confidence: 91%

“…Between 1985 and 2010, the number of people aged >80 years in the developed world has more than doubled to 53 million, and this trend is predicted to continue . Coronary artery disease is common in elderly patients: An estimated 13% of ST‐segment elevation myocardial infarction (STEMI) in Western cohorts occurs in patients aged >80 years . Consequently, as the population ages, we can expect to see more elderly patients presenting with STEMI.…”

Section: Introductionmentioning

confidence: 99%

“…1 Coronary artery disease is common in elderly patients: An estimated 13% of ST-segment elevation myocardial infarction (STEMI) in Western cohorts occurs in patients aged >80 years. 2 Consequently, as the population ages, we can expect to see more elderly patients presenting with STEMI. Furthermore, STEMI in elderly patients is associated with high mortality, estimated to be up to 47% at 1 year, which is unsurprising, given that comorbidities increase with age.…”

mentioning

confidence: 99%

“…9 PPCI in octogenarians is associated with improved survival compared with medical therapy alone, albeit often in subgroup analyses; [10][11][12][13][14][15] however, advanced age has been associated with worse outcomes after PPCI compared with younger patients in several recent cohort studies. 2,[16][17][18][19] Moreover, there is a paucity of evidence on the optimal management of STEMI in octogenarians as a result of their underrepresentation in clinical trials, the perceived increased risks related to comorbidities, and the presumed limited scope for symptomatic improvement. Nonetheless, there is no upper age limit for offering PPCI in current guidelines.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Outcome of 1051 Octogenarian Patients With ST‐Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group

Bromage

Jones

Rathod

et al. 2016

JAHA

View full text Add to dashboard Cite

Background ST‐segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention.Methods and ResultsWe analyzed 10 249 consecutive patients with ST‐segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all‐cause mortality at a median follow‐up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In‐hospital mortality (7.7% vs 2.4%, P<0.0001) and long‐term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07–1.09, P<0.0001). Time‐stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long‐term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts.ConclusionsIn this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in‐hospital outcomes were reasonable, and long‐term mortality rates were static.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Outcome of 1051 Octogenarian Patients With ST‐Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group

Bromage

Jones

Rathod

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…Few studies based on cohorts have suggested feasibility for invasive management of STEMI in nonagenarians 18–21. Our team has recently published the outcome of the largest series of nonagenarians presenting with STEMI, but data are limited to in-hospital follow-up only 22. Through this paper, we present data of the largest series of consecutive patients aged 90 years or older admitted with STEMI and treated by primary PCI in contemporary practice.…”

Section: Introductionmentioning

confidence: 99%

Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians

Petroni

Zaman

Hammoudi

et al. 2016

Heart

Self Cite

View full text Add to dashboard Cite

ObjectiveTo assess outcomes following primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients.MethodsWe conducted a multicentre retrospective study between 2006 and 2013 in five international high-volume centres and included consecutive all-comer nonagenarians treated with primary PCI for STEMI. There were no exclusion criteria. We enrolled 145 patients and collected demographic, clinical and procedural data. Severe clinical events and mortality at 6 months and 1 year were assessed.ResultsCardiogenic shock was present at admission in 21%. Median (IQR) delay between symptom onset and balloon was 3.7 (2.4–5.6) hours and 60% of procedures were performed through the transradial approach. Successful revascularisation of the culprit vessel was obtained in 86% of the cases (thrombolysis in myocardial infarction flow of 2 or 3). Major or clinically relevant bleeding was observed in 4% of patients. Median left ventricular ejection fraction post PCI was 41.5% (32.0–50.0). The in-hospital mortality was 24%, with 6 months and 1-year survival rates of 61% and 53%, respectively.ConclusionsIn our study, primary PCI in nonagenarians with STEMI was achieved and feasible through a transradial approach. It is associated with a high rate of reperfusion of the infarct-related artery and 53% survival at 1 year. These results suggest that primary PCI may be offered in selected nonagenarians with acute myocardial infarction.

show abstract

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Riehle

Gothe²,

Ebbinghaus

et al. 2023

Clin Res Cardiol

View full text Add to dashboard Cite

Aims We investigated the implementation of new guidelines in ST-segment elevation myocardial infarction (STEMI) patients in a large real-world patient population in the metropolitan area of Berlin (Germany) over a 20-year period. Methods From January 2000 to December 2019, a total of 25 792 patients were admitted with STEMI to one of the 34 member hospitals of the Berlin-Brandenburg Myocardial Infarction Registry (B2HIR) and were stratified for sex and age < 75 and ≥ 75 years. Results The median age of women was 72 years (IQR 61–81) compared to 61 years in men (IQR 51–71). PCI treatment as a standard of care was implemented in men earlier than in women across all age groups. It took two years from the 2017 class IA ESC STEMI guideline recommendation to prefer the radial access route rather than femoral until > 60% of patients were treated accordingly. In 2019, less than 60% of elderly women were treated via a radial access. While the majority of patients < 75 years already received ticagrelor or prasugrel as antiplatelet agent in the year of the class IA ESC STEMI guideline recommendation in 2012, men ≥ 75 years lagged two years and women ≥ 75 three years behind. Amongst the elderly, in-hospital mortality was 22.6% (737) for women and 17.3% (523) for men (p < 0.001). In patients < 75 years fatal outcome was less likely with 7.2% (305) in women and 5.8% (833) in men (p < 0.001). After adjustment for confounding variables, female sex was an independent predictor of in-hospital mortality in patients ≥ 75 years (OR 1.37, 95% CI 1.12–1.68, p = 0.002), but not in patients < 75 years (p = 0.076). Conclusion In-hospital mortality differs considerably by age and sex and remains highest in elderly patients and in particular in elderly females. In these patient groups, guideline recommended therapies were implemented with a significant delay. Graphical abstract

show abstract

Outcomes of primary percutaneous coronary interventions in nonagenarians with acute myocardial infarction

Cited by 38 publications

References 30 publications

Outcome of 1051 Octogenarian Patients With ST‐Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group

Outcome of 1051 Octogenarian Patients With ST‐Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group

Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians

Implementation of the ESC STEMI guidelines in female and elderly patients over a 20-year period in a large German registry

Contact Info

Product

Resources

About