Author + information
- Dominika Klimczak1,
- Mariusz Tomaniak2,
- Maria Tovar3,
- Marcella De Paolis4,
- Joost Daemen5,
- Jeroen Wilschut6,
- Peter de Jaegere7,
- Felix Zijlstra8,
- Nicolas Van Mieghem9 and
- Roberto Diletti10
- 1Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, Department of Immunology, Transplant Medicine and Internal Diseases, Division of Heart Failure and Cardiac Rehabilitation, Warsaw, Poland
- 2Thorax Center, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, First Department of Cardiology, Warsaw, Poland
- 3Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands
- 4Thoraxcenter, Erasmus MC, Department of Interventional Cardiology - SANTA MARIA Hospital, TERNI, ITALY, Rotterdam, TERNI, Terni, Italy
- 5Erasmus MC - Thoraxcenter, United States
- 6Thoraxcenter Erasmus MC, Rotterdam, Netherlands
- 7Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
- 8Thoraxcenter, Erasmus Medical Centre, Rotterdam, Netherlands
- 9Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 10Thorax Center, Erasmus MC, Rotterdam, Netherlands
Octogenarians represent a specific and rapidly growing patient subset. Data on the outcomes of primary percutaneous coronary intervention (PCI) and predictors of mortality among octogenarian patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited.
This is a single-centre, observational study of consecutive STEMI patients undergoing primary PCI in our tertiary care hospital between 2000-2011. Clinical outcomes were reported at one-year follow-up.
A total of 4884 STEMI patients with at least one-year follow-up was analyzed. A total of 374 patients at the age above 80 years (mean age 84.1 ± 3.1 years) were identified. Octogenarians were more frequently female (48% vs. 23%, p<0.001), hypertensive (47% vs. 36%, p<0.001), diabetic (16% vs. 12%, p=0.019) and more often had impaired renal function (4.8% vs. 1.5%, p<0.001) compared with younger patients. Despite higher 30-day (15.3%  vs. 4.8% , p<0.001) and 1-year mortality (24.5%  vs. 7.2% , p=0.001), the incidence of re-infarction (REMI) at 30 days (2.1%  vs. 1.8% , p=0.617) and 1-year follow-up (2.1%  vs. 2.7% , p=0.589) was similar in octogenarians and in the younger population. In octogenarians REMI was more frequently caused by stent thrombosis (72.7%  vs. 31.5% , p<0.001). REMI was more fatal (36.4 %  vs 3.2% , p<0.001) in patients above 80 years, compared to younger individuals. By multivariate Cox regression analysis adjusted for age and other confounders (p value ≤0.1 in univariate analysis) impaired renal function was an independent predictor of one-year mortality in octogenarian STEMI patients (HR 4.15, 95% CI: 1.52 — 11.3, p=0.005).
Although more frequently fatal and caused by stent thrombosis, re-infarction is not a frequent cause of mortality in STEMI patients above 80 years. Preservation of renal function is relevant for prognosis after primary PCI in octogenarian population.
CORONARY: Acute Myocardial Infarction