The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction

  • Kim, Joon Young (Department of Cardiovascular Medicine, Yeocheon Chonnam Hospital) ;
  • Jeong, Myung Ho (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Choi, Yong Woo (Department of Cardiovascular Medicine, Yeocheon Chonnam Hospital) ;
  • Ahn, Yong Keun (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Chae, Shung Chull (Department of Cardiovascular Medicine, Kyungpook National University Hospital) ;
  • Hur, Seung Ho (Department of Cardiovascular Medicine, Keimyung University Dongsan Medical Center) ;
  • Hong, Taek Jong (Department of Cardiovascular Medicine, Pusan National University Hospital) ;
  • Kim, Young Jo (Department of Cardiovascular Medicine, Yeungnam University Medical Center) ;
  • Seong, In Whan (Department of Cardiovascular Medicine, Chungnam National University Hospital) ;
  • Chae, In Ho (Department of Cardiovascular Medicine, Seoul National University Bundang Hospital) ;
  • Cho, Myeong Chan (Department of Cardiovascular Medicine, Chungbuk National University Hospital) ;
  • Yoon, Jung Han (Department of Cardiovascular Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Seung, Ki Bae (Department of Cardiovascular Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2014.08.14
  • Accepted : 2014.11.13
  • Published : 2015.11.01
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Abstract

Background/Aims: Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited. The aim of the present study was to evaluate the temporal trends and in-hospital outcomes of primary PCI in nonagenarian STEMI patients. Methods: We retrospectively reviewed data from the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008, and from the Korea Working Group on Myocardial Infarction (KorMI) from February 2008 to May 2010. Results: During this period, the proportion of nonagenarians among STEMI patients more than doubled (0.59% in KAMIR vs. 1.35% in KorMI), and the rate of use of primary PCI also increased (from 62.5% in KAMIR to 81.0% in KorMI). We identified 84 eligible study patients for which the overall in-hospital mortality rate was 21.4% (25.0% in KAMIR vs. 20.3% in KorMI, p = 0.919). Multivariate analysis identified two independent predictors of in-hospital mortality, namely a final Thrombolysis in Myocardial Infarction (TIMI) flow < 3 (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.2 to 59.0; p < 0.001) and cardiogenic shock during hospitalization (OR, 6.7; 95% CI, 1.5 to 30.3; p = 0.013). Conclusions: The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow < 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate.

Keywords

References

  1. White HD, Barbash GI, Califf RM, et al. Age and outcome with contemporary thrombolytic therapy: results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation 1996;94:1826-1833. https://doi.org/10.1161/01.CIR.94.8.1826
  2. Showkathali R, Boston-Griffiths E, Parker M, et al. Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting with ST elevation myocardial infarction? J Cardiovasc Med (Hagerstown) 2014;15:53-59. https://doi.org/10.2459/JCM.0b013e3283649978
  3. 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;286:708-713. https://doi.org/10.1001/jama.286.6.708
  4. Korea Acute Myocardial Infarction Registry (KAMIR) Investigators, Lee KH, Jeong MH, et al. Gender differences of success rate of percutaneous coronary intervention and short term cardiac events in Korea Acute Myocardial Infarction Registry. Int J Cardiol 2008;130:227-234. https://doi.org/10.1016/j.ijcard.2007.08.044
  5. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245-1251. https://doi.org/10.1016/0895-4356(94)90129-5
  6. Hovanesyan A, Rich MW. Outcomes of acute myocardial infarction in nonagenarians. Am J Cardiol 2008;101:1379-1383. https://doi.org/10.1016/j.amjcard.2008.01.012
  7. Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007;115:2570-2589. https://doi.org/10.1161/CIRCULATIONAHA.107.182616
  8. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, et al. ACC/ AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006;113:e166-e286. https://doi.org/10.1161/CIRCULATIONAHA.106.173220
  9. King SB 3rd, Smith SC Jr, Hirshfeld JW Jr, et al. 2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association task force on practice guidelines: 2007 writing group to review new evidence and update the ACC/AHA/ SCAI 2005 guideline update for percutaneous coronary intervention, writing on behalf of the 2005 Writing Committee. Circulation 2008;117:261-295. https://doi.org/10.1161/CIRCULATIONAHA.107.188208
  10. Bueno H, Betriu A, Heras M, et al. Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J 2011;32:51-60. https://doi.org/10.1093/eurheartj/ehq375
  11. Danzi GB, Centola M, Pomidossi GA, et al. Usefulness of primary angioplasty in nonagenarians with acute myocardial infarction. Am J Cardiol 2010;106:770-773. https://doi.org/10.1016/j.amjcard.2010.04.041
  12. Koutouzis M, Grip L, Matejka G, Albertsson P. Primary percutaneous coronary interventions in nonagenarians. Clin Cardiol 2010;33:157-161. https://doi.org/10.1002/clc.20720
  13. Salinas P, Galeote G, Martin-Reyes R, et al. Primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction in nonagenarian patients: results from a Spanish multicentre registry. EuroIntervention 2011;6:1080-1084. https://doi.org/10.4244/EIJV6I9A188
  14. Rigattieri S, Cera M, Sciahbasi A, et al. Primary percutaneous coronary intervention in nonagenarians: six-month outcomes from a single-center registry. J Invasive Cardiol 2013;25:242-245.
  15. Ionescu CN, Amuchastegui M, Ionescu S, Marcu CB, Donohue T. Treatment and outcomes of nonagenarians with ST-elevation myocardial infarction. J Invasive Cardiol 2010;22:474-478.
  16. Eagle KA, Goodman SG, Avezum A, et al. Practice variation and missed opportunities for reperfusion in ST-segment- elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet 2002;359:373-377. https://doi.org/10.1016/S0140-6736(02)07595-5
  17. Mandawat A, Mandawat A, Mandawat MK. Percutaneous coronary intervention after ST-segment elevation myocardial infarction in nonagenarians: use rates and in-hospital mortality. J Am Coll Cardiol 2013;61:1207-1208. https://doi.org/10.1016/j.jacc.2012.12.019
  18. Dziewierz A, Siudak Z, Rakowski T, Dubiel JS, Dudek D. Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty. J Thromb Thrombolysis 2012;34:214-221. https://doi.org/10.1007/s11239-012-0713-y
  19. Valente S, Lazzeri C, Salvadori C, et al. Effectiveness and safety of routine primary angioplasty in patients aged> or =85 years with acute myocardial infarction. Circ J 2008;72:67-70. https://doi.org/10.1253/circj.72.67
  20. Shah P, Najafi AH, Panza JA, Cooper HA. Outcomes and quality of life in patients>or=85 years of age with ST-elevation myocardial infarction. Am J Cardiol 2009;103:170-174. https://doi.org/10.1016/j.amjcard.2008.08.051

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