Incremental age-related one-year MACCE after acute myocardial infarction in the drug-eluting stent era (from KAMIR-NIH registry)

OBJECTIVES: To evaluate the age-related one-year major adverse cardiocerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). We analyzed the association between age and one-year MACCE after AMI. METHODS: A total of 13,104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institue of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into four groups according to age (Group I, < 60 years, n = 4199; Group II, 60–70 years, n = 2577; Group III; 70–80 years, n = 2774; Group IV, ≥ 80 years, n = 1018). Patients were analyzed for one-year composite of MACCE (cardiac death, myocardial infarction, target vessel revascularization, cerebrovascular events) after AMI. RESULTS: The one-year MACCE in AMI were 3.5% (Group I), 6.3% (Group II), 9.6% (Group III) and 17.6% (Group IV). After adjustment for confounding parameters, the analysis results showed that patients with AMI had incremental risk of one-year MACCE [Group II, adjusted hazard ratios (aHR) = 1.224, 95% CI: 0.965–1.525, P = 0.096; Group III, aHR = 1.316, 95% CI: 1.037–1.671, P = 0.024; Group IV, aHR = 1.975, 95% CI: 1.500–62.601, P < 0.001) compared to Group I. Especially, cardiac death in the composite of primary end point played a major role in this effect (Group II, aHR = 1.335, 95% CI: 0.941–1.895, P = 0.106; Group III, aHR = 1.575, 95% CI: 1.122–2.210, P = 0.009; Group IV, aHR = 2.803, 95% CI: 1.937–4.054, P < 0.001). CONCLUSIONS: Despite advanced techniques and medications for PCI in AMI, age still exerts a powerful influence in clinical outcomes. Careful approaches, even in the modern era of developed cardiology are needed for aged-population in AMI intervention.