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The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy
BACKGROUND: There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing P...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247595/ https://www.ncbi.nlm.nih.gov/pubmed/32546989 http://dx.doi.org/10.2147/CIA.S218827 |
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author | Helber, Izo Alves, Claudia Maria Rodrigues Grespan, Stela Maris Veiga, Eduardo C A Moraes, Pedro I M Souza, José Marconi Barbosa, Adriano H Gonçalves Jr, Iran Fonseca, Francisco A H Carvalho, Antônio Carlos C Caixeta, Adriano |
author_facet | Helber, Izo Alves, Claudia Maria Rodrigues Grespan, Stela Maris Veiga, Eduardo C A Moraes, Pedro I M Souza, José Marconi Barbosa, Adriano H Gonçalves Jr, Iran Fonseca, Francisco A H Carvalho, Antônio Carlos C Caixeta, Adriano |
author_sort | Helber, Izo |
collection | PubMed |
description | BACKGROUND: There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS. METHODS: Between January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation. RESULTS: A total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥75 years of age. Compared to patients <75 years, those ≥75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients <75 years of age, in-hospital MACE and mortality were higher in patients with ≥75 years (6.5% versus 19.4%; p<0.001; and 4.0% versus 18.2%; p<0.001, respectively). Patients ≥75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p<0.001). By multivariable analysis, age ≥75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12–3.82, p=0.020). CONCLUSION: In patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients <75 years of age. |
format | Online Article Text |
id | pubmed-7247595 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-72475952020-06-15 The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy Helber, Izo Alves, Claudia Maria Rodrigues Grespan, Stela Maris Veiga, Eduardo C A Moraes, Pedro I M Souza, José Marconi Barbosa, Adriano H Gonçalves Jr, Iran Fonseca, Francisco A H Carvalho, Antônio Carlos C Caixeta, Adriano Clin Interv Aging Original Research BACKGROUND: There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS. METHODS: Between January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation. RESULTS: A total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥75 years of age. Compared to patients <75 years, those ≥75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients <75 years of age, in-hospital MACE and mortality were higher in patients with ≥75 years (6.5% versus 19.4%; p<0.001; and 4.0% versus 18.2%; p<0.001, respectively). Patients ≥75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p<0.001). By multivariable analysis, age ≥75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12–3.82, p=0.020). CONCLUSION: In patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients <75 years of age. Dove 2020-05-21 /pmc/articles/PMC7247595/ /pubmed/32546989 http://dx.doi.org/10.2147/CIA.S218827 Text en © 2020 Helber et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Helber, Izo Alves, Claudia Maria Rodrigues Grespan, Stela Maris Veiga, Eduardo C A Moraes, Pedro I M Souza, José Marconi Barbosa, Adriano H Gonçalves Jr, Iran Fonseca, Francisco A H Carvalho, Antônio Carlos C Caixeta, Adriano The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy |
title | The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy |
title_full | The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy |
title_fullStr | The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy |
title_full_unstemmed | The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy |
title_short | The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy |
title_sort | impact of advanced age on major cardiovascular events and mortality in patients with st-elevation myocardial infarction undergoing a pharmaco-invasive strategy |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247595/ https://www.ncbi.nlm.nih.gov/pubmed/32546989 http://dx.doi.org/10.2147/CIA.S218827 |
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