Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Roberta Sappa, Maria Teresa Grillo, Martino Cinquetti, Giulio Prati, Leonardo Spedicato, Gaetano Nucifora, Andrea Perkan, Davide Zanuttini, Gianfranco Sinagra, Alessandro Proclemer

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥ 85 years with ST-Elevation Myocardial Infarction (STEMI). Methods and Results We analyzed 126 consecutive patients aged ≥ 85 years (age 88 ± 2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score > 8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. Conclusions PPCI in patients ≥ 85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.

LanguageEnglish
Pages112-118
Number of pages7
JournalInternational Journal of Cardiology
Volume249
DOIs
Publication statusPublished - 15 Dec 2017
Externally publishedYes

Keywords

  • Long-term outcome
  • Primary percutaneous coronary intervention
  • ST-elevation myocardial infarction
  • Very elderly

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sappa, Roberta ; Grillo, Maria Teresa ; Cinquetti, Martino ; Prati, Giulio ; Spedicato, Leonardo ; Nucifora, Gaetano ; Perkan, Andrea ; Zanuttini, Davide ; Sinagra, Gianfranco ; Proclemer, Alessandro. / Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. In: International Journal of Cardiology. 2017 ; Vol. 249. pp. 112-118.
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abstract = "Background Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥ 85 years with ST-Elevation Myocardial Infarction (STEMI). Methods and Results We analyzed 126 consecutive patients aged ≥ 85 years (age 88 ± 2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19{\%}. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31{\%}) patients died during follow-up. 55 patients (54{\%}) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score > 8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. Conclusions PPCI in patients ≥ 85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.",
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Sappa, R, Grillo, MT, Cinquetti, M, Prati, G, Spedicato, L, Nucifora, G, Perkan, A, Zanuttini, D, Sinagra, G & Proclemer, A 2017, 'Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention', International Journal of Cardiology, vol. 249, pp. 112-118. https://doi.org/10.1016/j.ijcard.2017.09.025

Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. / Sappa, Roberta; Grillo, Maria Teresa; Cinquetti, Martino; Prati, Giulio; Spedicato, Leonardo; Nucifora, Gaetano; Perkan, Andrea; Zanuttini, Davide; Sinagra, Gianfranco; Proclemer, Alessandro.

In: International Journal of Cardiology, Vol. 249, 15.12.2017, p. 112-118.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

AU - Sappa, Roberta

AU - Grillo, Maria Teresa

AU - Cinquetti, Martino

AU - Prati, Giulio

AU - Spedicato, Leonardo

AU - Nucifora, Gaetano

AU - Perkan, Andrea

AU - Zanuttini, Davide

AU - Sinagra, Gianfranco

AU - Proclemer, Alessandro

PY - 2017/12/15

Y1 - 2017/12/15

N2 - Background Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥ 85 years with ST-Elevation Myocardial Infarction (STEMI). Methods and Results We analyzed 126 consecutive patients aged ≥ 85 years (age 88 ± 2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score > 8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. Conclusions PPCI in patients ≥ 85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.

AB - Background Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥ 85 years with ST-Elevation Myocardial Infarction (STEMI). Methods and Results We analyzed 126 consecutive patients aged ≥ 85 years (age 88 ± 2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score > 8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. Conclusions PPCI in patients ≥ 85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.

KW - Long-term outcome

KW - Primary percutaneous coronary intervention

KW - ST-elevation myocardial infarction

KW - Very elderly

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