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Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?

BACKGROUND: Primary percutaneous intervention (PPCI) is the treatment of choice for ST elevation myocardial infarction (STEMI) but robust evidence in the very elderly is lacking. We compared PPCI outcomes between different age quartiles (quartile 1 < 60 years, quartile 2 ≥ 60 to < 70 years, qu...

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Autores principales: Sharma, Vinoda, Srinivasan, Manivannan, Smith, Dave
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460170/
https://www.ncbi.nlm.nih.gov/pubmed/26089851
http://dx.doi.org/10.11909/j.issn.1671-5411.2015.03.007
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author Sharma, Vinoda
Srinivasan, Manivannan
Smith, Dave
author_facet Sharma, Vinoda
Srinivasan, Manivannan
Smith, Dave
author_sort Sharma, Vinoda
collection PubMed
description BACKGROUND: Primary percutaneous intervention (PPCI) is the treatment of choice for ST elevation myocardial infarction (STEMI) but robust evidence in the very elderly is lacking. We compared PPCI outcomes between different age quartiles (quartile 1 < 60 years, quartile 2 ≥ 60 to < 70 years, quartile 3 ≥ 70 to < 80 years, quartile 4 ≥ 80 years). METHODS: Retrospective observational analysis of our Morriston Tertiary Cardiac Center (Abertawe Bro Morgannwg University Health Board) patients from 2005 to 2010 with STEMI who underwent PPCI. RESULTS: Of 434 patients, 57 (13%) were in quartile 4 (≥ 80 years). In older age quartiles, patients were less likely to receive a drug eluting stent (DES, P = 0.001) or glycoprotein IIb/IIIa inhibitor (GPI, P < 0.0001). Increase in age was associated with reduced time to survival (β-coefficient: −0.192, t: −3.70, 95%CI: −4.91 to −1.50, P < 0.0001) as was the presence of cardiogenic shock (β-coefficient: −0.194, t = 3.77, 95%CI: −5.26 to −1.65, P < 0.0001). Use of GPI was associated with increased time to survival (β-coefficient: 0.138, t = 2.82, 95%CI: 1.58–8.58, P = 0.005) but older age quartiles were less likely to receive GPI (P < 0.0001). In-hospital mortality (1.8% quartile 1, 3.6% quartile 2, 10.9% quartile 3 and 12.3% quartile 4, P = 0.002) and 1-year mortality (5.4% quartile 1, 5.5% quartile 2, 16.8% quartile 3 and 24.6% quartile 4, P < 0.0001, respectively) was significantly higher in older age quartiles. CONCLUSIONS: Increased short term and intermediate term mortality is seen in the very elderly after PPCI. Age and cardiogenic shock were prognostic factors. Intervention should not be based on age alone and awareness regarding prognostic factors can help improve management.
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spelling pubmed-44601702015-06-18 Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet? Sharma, Vinoda Srinivasan, Manivannan Smith, Dave J Geriatr Cardiol Research Article BACKGROUND: Primary percutaneous intervention (PPCI) is the treatment of choice for ST elevation myocardial infarction (STEMI) but robust evidence in the very elderly is lacking. We compared PPCI outcomes between different age quartiles (quartile 1 < 60 years, quartile 2 ≥ 60 to < 70 years, quartile 3 ≥ 70 to < 80 years, quartile 4 ≥ 80 years). METHODS: Retrospective observational analysis of our Morriston Tertiary Cardiac Center (Abertawe Bro Morgannwg University Health Board) patients from 2005 to 2010 with STEMI who underwent PPCI. RESULTS: Of 434 patients, 57 (13%) were in quartile 4 (≥ 80 years). In older age quartiles, patients were less likely to receive a drug eluting stent (DES, P = 0.001) or glycoprotein IIb/IIIa inhibitor (GPI, P < 0.0001). Increase in age was associated with reduced time to survival (β-coefficient: −0.192, t: −3.70, 95%CI: −4.91 to −1.50, P < 0.0001) as was the presence of cardiogenic shock (β-coefficient: −0.194, t = 3.77, 95%CI: −5.26 to −1.65, P < 0.0001). Use of GPI was associated with increased time to survival (β-coefficient: 0.138, t = 2.82, 95%CI: 1.58–8.58, P = 0.005) but older age quartiles were less likely to receive GPI (P < 0.0001). In-hospital mortality (1.8% quartile 1, 3.6% quartile 2, 10.9% quartile 3 and 12.3% quartile 4, P = 0.002) and 1-year mortality (5.4% quartile 1, 5.5% quartile 2, 16.8% quartile 3 and 24.6% quartile 4, P < 0.0001, respectively) was significantly higher in older age quartiles. CONCLUSIONS: Increased short term and intermediate term mortality is seen in the very elderly after PPCI. Age and cardiogenic shock were prognostic factors. Intervention should not be based on age alone and awareness regarding prognostic factors can help improve management. Science Press 2015-05 /pmc/articles/PMC4460170/ /pubmed/26089851 http://dx.doi.org/10.11909/j.issn.1671-5411.2015.03.007 Text en Institute of Geriatric Cardiology http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.
spellingShingle Research Article
Sharma, Vinoda
Srinivasan, Manivannan
Smith, Dave
Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?
title Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?
title_full Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?
title_fullStr Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?
title_full_unstemmed Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?
title_short Age and outcomes of primary percutaneous intervention for ST elevation myocardial infarction in a tertiary center—are we there yet?
title_sort age and outcomes of primary percutaneous intervention for st elevation myocardial infarction in a tertiary center—are we there yet?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460170/
https://www.ncbi.nlm.nih.gov/pubmed/26089851
http://dx.doi.org/10.11909/j.issn.1671-5411.2015.03.007
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