2011, Number 1
Results of primary angioplasty in patients more than 75 years old with acute myocardial infarction. Comparative study
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Language: Spanish
References: 33
Page: 17-23
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ABSTRACT
These is one observational descriptive and retrospective study that shows the comparative results in patients (Pts) › of 75 years versus ≤ of 75 years undergoing primary angioplasty (PA) for acute ST elevation myocardial infarction (STEMI). Material and methods: We analyzed the results of 800 Pts who underwent PA for STEMI; 82 Pts (10.5%) were › of 75 years (Group I) and 718 Pts were ≤ of 75 years (Group II), the inclusion criterion were patients with a diagnosis of STEMI with an evolution ≤ 12 hours, the primary endpoints were the incidence in hospital of major cardiovascular events (MCE) (Reinfarction, new reintervention, Death or new beginning of cardiac failure). Results: Group I showed older age 78.68 ± 3.98 years compared with the 58.46 ± 9.9 years of group II, the percentage of female patients was 34, 1% for group I versus 20.6% for group II, a higher comorbidity in group I consisting in hypertension (HT), previous myocardial infarction, depressed left ventricular function (LVEF%), multivessel disease(MVD) (all p ‹ 0.05). The Symptom-Balloon time (Sx-B) was very similar for both Groups (p ‹ NS). A pre procedural TIMI flow of 0-1 and the use of coronary stenting were similar in both groups. (p = NS), the use of IIb/IIIa was higher in group I (36.6% vs 30.4 p ‹ 0.042); a post procedural TIMI III flow and residual angiographic stenosis were similar in both groups (boths p:NS); there was a higher incidence of MCE in group I, consisting of intracranial hemorrhage (ICH) which appeared in 2 Pts (2.46%) vs 0% (p ‹ 0.43), Cardiogenic Shock (CCh) which appeared in 16% vs. 8.7% (p ‹ 0,031), in hospital mortality was 20.7% vs 11.4% (p ‹ 0.001) (with CCh) and of 16.9% vs 4.9% (without CCh) (p ‹ 0.0001): With the bivaried analysis the predicting factors of mortality were a) MVD, b) Higher incidence of left descending artery (DA) disease, c) High prevalence of C Ch. d) Low LVEF % Conclusion: Our results show that PA can be use as a first therapeutic option in acute STEMI in Pts › 75 years: The reperfusion rate can be reached in a similar proportion as with patients ‹ 75 years. Mortality was also lower compared with reports of non percutaneous coronary intervention registries. The higher rate of MVD, ChC, low LVEF, predispose to higher mortality in a shorter period of time.REFERENCES
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