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Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly

BACKGROUND: The population is ageing rapidly and the proportion of patients aged ≥ 80 years undergoing primary percutaneous coronary intervention (PCI) is rising, but clinical trials have primarily been performed in younger patients. METHODS: Patients undergoing primary PCI between 2003 and 2008 wer...

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Autores principales: Claessen, Bimmer E.P.M., Kikkert, Wouter J., Hoebers, Loes P., Bahadurzada, Hassina, Vis, Marije M., Baan, Jan, Koch, Karel T., de Winter, Robbert J., Tijssen, Jan G.P., Piek, Jan J., Henriques, José P.S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bohn Stafleu van Loghum 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580666/
https://www.ncbi.nlm.nih.gov/pubmed/26259967
http://dx.doi.org/10.1007/s12471-015-0733-2
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author Claessen, Bimmer E.P.M.
Kikkert, Wouter J.
Hoebers, Loes P.
Bahadurzada, Hassina
Vis, Marije M.
Baan, Jan
Koch, Karel T.
de Winter, Robbert J.
Tijssen, Jan G.P.
Piek, Jan J.
Henriques, José P.S.
author_facet Claessen, Bimmer E.P.M.
Kikkert, Wouter J.
Hoebers, Loes P.
Bahadurzada, Hassina
Vis, Marije M.
Baan, Jan
Koch, Karel T.
de Winter, Robbert J.
Tijssen, Jan G.P.
Piek, Jan J.
Henriques, José P.S.
author_sort Claessen, Bimmer E.P.M.
collection PubMed
description BACKGROUND: The population is ageing rapidly and the proportion of patients aged ≥ 80 years undergoing primary percutaneous coronary intervention (PCI) is rising, but clinical trials have primarily been performed in younger patients. METHODS: Patients undergoing primary PCI between 2003 and 2008 were subdivided into 3 groups: < 60, 60-79, and ≥ 80 years. Endpoints at 3-year follow-up included all-cause mortality, recurrent myocardial infarction (reMI), stent thrombosis, target lesion revascularisation (TLR), bleeding (BARC bleeding ≥ 3), stroke, and major adverse cardiovascular events (MACE, a composite of cardiac mortality, reMI, stroke and TLR). RESULTS: 2002 patients with ST-segment elevation myocardial infarction (STEMI) were included, 885 (44.2 %) aged < 60, 921 (46.0 %) 60–79, and 196 (9.7 %) ≥ 80 years. Comorbidities such as diabetes mellitus, prior stroke, malignant disease, anaemia, and chronic kidney disease were more prevalent in patients ≥ 80 years. The incidence of both ischaemic and bleeding events strongly increased with age. Age ≥ 80 years was an independent predictor of mortality (HR 2.56, 95 % CI1.69–3.87, p < 0.001), a borderline non-significant predictor of overall bleeding (HR 1.38, 95 %CI 0.95–2.00, p = 0.088), and a significant predictor of non-access site bleeding (HR 2.26, 95 %CI 1.46–3.51, p < 0.001). CONCLUSION: Patients ≥ 80 years experienced high rates of ischaemic and bleeding complications; especially in this high-risk patient group individualised therapy is needed to optimise clinical outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12471-015-0733-2 contains supplementary material, which is available to authorized users.
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spelling pubmed-45806662015-09-25 Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly Claessen, Bimmer E.P.M. Kikkert, Wouter J. Hoebers, Loes P. Bahadurzada, Hassina Vis, Marije M. Baan, Jan Koch, Karel T. de Winter, Robbert J. Tijssen, Jan G.P. Piek, Jan J. Henriques, José P.S. Neth Heart J Original Article BACKGROUND: The population is ageing rapidly and the proportion of patients aged ≥ 80 years undergoing primary percutaneous coronary intervention (PCI) is rising, but clinical trials have primarily been performed in younger patients. METHODS: Patients undergoing primary PCI between 2003 and 2008 were subdivided into 3 groups: < 60, 60-79, and ≥ 80 years. Endpoints at 3-year follow-up included all-cause mortality, recurrent myocardial infarction (reMI), stent thrombosis, target lesion revascularisation (TLR), bleeding (BARC bleeding ≥ 3), stroke, and major adverse cardiovascular events (MACE, a composite of cardiac mortality, reMI, stroke and TLR). RESULTS: 2002 patients with ST-segment elevation myocardial infarction (STEMI) were included, 885 (44.2 %) aged < 60, 921 (46.0 %) 60–79, and 196 (9.7 %) ≥ 80 years. Comorbidities such as diabetes mellitus, prior stroke, malignant disease, anaemia, and chronic kidney disease were more prevalent in patients ≥ 80 years. The incidence of both ischaemic and bleeding events strongly increased with age. Age ≥ 80 years was an independent predictor of mortality (HR 2.56, 95 % CI1.69–3.87, p < 0.001), a borderline non-significant predictor of overall bleeding (HR 1.38, 95 %CI 0.95–2.00, p = 0.088), and a significant predictor of non-access site bleeding (HR 2.26, 95 %CI 1.46–3.51, p < 0.001). CONCLUSION: Patients ≥ 80 years experienced high rates of ischaemic and bleeding complications; especially in this high-risk patient group individualised therapy is needed to optimise clinical outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12471-015-0733-2 contains supplementary material, which is available to authorized users. Bohn Stafleu van Loghum 2015-08-11 2015-09 /pmc/articles/PMC4580666/ /pubmed/26259967 http://dx.doi.org/10.1007/s12471-015-0733-2 Text en © The Author(s) 2015 https://creativecommons.org/licenses/by/4.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original Article
Claessen, Bimmer E.P.M.
Kikkert, Wouter J.
Hoebers, Loes P.
Bahadurzada, Hassina
Vis, Marije M.
Baan, Jan
Koch, Karel T.
de Winter, Robbert J.
Tijssen, Jan G.P.
Piek, Jan J.
Henriques, José P.S.
Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly
title Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly
title_full Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly
title_fullStr Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly
title_full_unstemmed Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly
title_short Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly
title_sort long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for st-elevation myocardial infarction in the elderly
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580666/
https://www.ncbi.nlm.nih.gov/pubmed/26259967
http://dx.doi.org/10.1007/s12471-015-0733-2
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