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Successful primary coronary angioplasty improves early and long-term outcomes in ST segment elevation acute coronary syndromes in patients above 80 years of age
Hanna Rymuza, Ilona Kowalik, Andrzej Drzewiecki, Wojciech Krzyżanowski, Maciej Olszewski, Rafał Dąbrowski, Barbara Jędrzejczyk, Jacek Woźniak, Cezary Sosnowski, Hanna Szwed
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DOI: 10.33963/v.kp.79350
Kardiol Pol 2011;69(4):346-354.
Abstract
Background: ST segment elevation myocardial infarction (STEMI) in patients above 80 years of age continues to be a therapeuticchallenge. Patients in this age group are rarely included in randomised clinical trials.
Aim: Comparison of the effectiveness and safety of STEMI management in octogenarians in hospitals with a 24-hour percutaneouscoronary intervention (PCI) capability and hospitals without PCI access.
Methods: A retrospective analysis of medical records of 50 octogenarians who were treated with PCI (group 1) in one centerand 50 patients treated noninvasively in the other 3 hospitals (group 2). We evaluated mortality and major adverse cardiacevents after 10 days, 30 days and 1 year.
Results: There were no significant differences in the demographic characteristics of the study groups. The duration of coronarypain was similar in both groups: 318 min in group 1 vs 383 min in group 2 (NS). Mortality in group 2 was significantlyhigher than in group 1: 40% vs 14%, respectively, after 10 days (p = 0.0034); 48 vs 18% after 30 days (p = 0.0014); and 54%vs 24% after 1 year (p = 0.0021). Thrombolytic treatment was used in only 40% of the patients in group 2. In group 2, acuteheart failure (HF) (Killip class III and IV) was diagnosed more frequently than in group 1 (28% vs 12%, p = 0.034). In patientswith Killip class I/II HF, mortality in patients in group 2 and group 1 was 22% vs 9%, at 10 days; 31% vs 14% at 30 days; and39% vs 20% at 1 year. In patients with Killip class III/IV HF, mortality was 86% vs 50%, at 10 days; 93% vs 50% at 30 days; and93% vs 50% at 1 year, respectively (all differences NS). In multivariate analysis adjusted for the differences between groups,HF (a negative effect) and a successful PCI (a positive effect) were independent predictors of 1-year survival.
Conclusions: Successful primary PCI in STEMI patients above 80 years of age resulted in a reduction of early and long-termmortality compared to the medically treated patients. The benefits of PCI treatment accrued during the follow-up. In patientstreated in the tertiary reference centre in whom PCI was not successful or was not deemed feasible, prognosis was similar tothat in the medically treated patients. The latter patients rarely received thrombolytic treatment.
Kardiol Pol 2011; 69, 4: 346-354
Keywords: STEMIprimary percutaneous coronary interventionprognosisoctogenarians
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