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2007, Number 3

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Arch Cardiol Mex 2007; 77 (3)

Predictors of mortality and adverse outcome in elderly high-risk patients undergoing percutaneous coronary intervention

Miranda ME, Peña DMA, Castellanos J, Exaire E, Arrieta O, Salazar DE, Villavicencio FR, Delgadillo-Rodríguez H, González-Quesada CJ, Martínez-Ríos MA

Language: English
References: 26
Page: 194-199
PDF size: 95.62 Kb.


ABSTRACT

Objectives: We sought to identify predictors of in-hospital and long-term (› 1 year) mortality and major adverse cardiac events (MACE) in elderly patients referred for percutaneous coronary intervention (PCI). Methods: Seventy-three patients (≥ 80 years) were included. Clinical and interventional characteristics were collected retrospectively. Primary end points were in-hospital and long-term mortality, and a composite of non-fatal myocardial infarction, target vessel revascularization, urgent coronary artery bypass graft surgery, and death (MACE). Results: Eighty-three percent of the patients had acute coronary syndromes, 43% three-vessel disease, and 42% heart failure. In-hospital mortality and MACE were 16.4% and 19%, respectively. Long-term mortality and MACE were 11.3% and 16.4%, respectively. Univariate characteristics associated with in-hospital mortality and MACE were: Killip Class III-IV, heart failure, cardiogenic shock, TIMI 0-2 flow prior and after intervention, diabetes mellitus, contrast nephropathy, and presence of A-V block or atrial fibrillation (AF). Long term predictors for mortality were the presence of heart failure, cardiogenic shock, diabetes mellitus, TIMI flow 0-2 before and after intervention, and A-V block or AF. Conclusion: The identification of the factors previously mentioned may help to predict complications in elderly patients.


REFERENCES

  1. Wenger NK, O’Rourke RA, Marcus FI: The care of elderly patients with cardiovascular disease. Ann Intern Med. 1988; 109(5): 425-8.

  2. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O’Keefe J, et al: A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1993; 328(10): 673-9.

  3. Guagliumi G, Stone GW, Cox DA, Stuckey T, Tcheng JE, Turco M, et al: Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation 2004; 110(12): 1598-604.

  4. Pfisterer M, Buser P, Osswald S, Allemann U, Amann W, Angehm W, et al: Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: one-year results of the randomized TIME trial. JAMA 2003; 289(9): 1117-23.

  5. Peterson ED, Alexander KP, Malenka DJ, Hannan EL, O’Conner GT, McCallister BD: Multicenter experience in revascularization of very elderly patients. Am Heart J 2004; 148(3): 486-92.

  6. Barakat K, Wilkinson P, Deaner A, Fluck D, Ranjadayalan K, Timmis A: How should age affect management of acute myocardial infarction? A prospective cohort study. Lancet 1999; 353(9157): 955-9.

  7. Batchelor WB, Anstrom KJ, Muhlbaier LH, Grosswald R, Weintraub WS, O’Neil WW, et al: Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. J Am Coll Cardiol 2000; 36(3): 723-30.

  8. Graham MM, Ghali WA, Faris PD, Galbraith PD, Norris CM, Knudtson ML: Survival after coronary revascularization in the elderly. Circulation 2002; 105(20): 2378-84.

  9. Gurwitz JH, Col NF, Avorn J: The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992; 268(11): 1417-22.

  10. Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED: Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 2001; 286(6): 708-13.

  11. TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 1985; 312(14): 932-6.

  12. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al: Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341(9): 625-34.

  13. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003; 108(17): 2154-69.

  14. Levey AS, Coresh J, Balk E, Karusz AT, Levin A, Steffes MW, et al: National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139(2): 137-47.

  15. Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S: Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001; 134(8): 629-36.

  16. Beddhu S, Allen-Brady K, Cheung AK, Horne BD, Bair T, Muhlestein JB et al: Impact of renal failure on the risk of myocardial infarction and death. Kidney Int 2002; 62(5): 1776-83.

  17. Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP, et al: Cardiovascular disease risk status in elderly persons with renal insufficiency. Kidney Int 2002; 62(3): 997-1004.

  18. Edwards MS, Craven TE, Burke GL, Dean RH, Hansen KJ: Renovascular disease and the risk of adverse coronary events in the elderly: a prospective, population-based study. Arch Intern Med 2005; 165(2): 207-13.

  19. Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, et al: Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004; 351(13): 1285-95.

  20. Abidov A, Kaluski E, Hod H, Leor J, Vered Z, Gottlieb S, et al: Influence of conduction disturbances on clinical outcome in patients with acute myocardial infarction receiving thrombolysis (results from the ARGAMI-2 study). Am J Cardiol 2004; 93(1): 76-80.

  21. Lehto M, Snapinn S, Dickstein K, Swedberg K, Nieminen MS: Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience. Eur Heart J 2005; 26(4): 350-6.

  22. Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, et al: Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J 2005; 149(4): 670-4.

  23. Holmes DR, Jr., White HD, Pieper KS, Ellis SG, Califf RM, Topol EJ: Effect of age on outcome with primary angioplasty versus thrombolysis. J Am Coll Cardiol 1999; 33(2): 412-9.

  24. DeGeare VS, Stone GW, Grines L, Brodie BR, Cox DA, Garcia E, et al: Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials). Am J Cardiol 2000; 86(1): 30-4.

  25. Carnendran L, Abboud R, Sleeper LA, Gurunathan R, Webb JG, Menon V, et al: Trends in cardiogenic shock: report from the SHOCK Study. The should we emergently revascularize Occluded Coronaries for cardiogenic shock? Eur Heart J 2001; 22(6): 472-8.

  26. Mehta RH, Sadiq I, Goldberg RJ, Gore JM, Avezum A, Spencer F, et al: Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction. Am Heart J 2004; 147(2): 253-9.




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