Primary PCI at the age of 70 and more - in-hospital results

Background: At present the primary coronary intervention (primary PCI) has been accepted as a method of choice in the reperfusion treatment of the ST-elevation acute myocardial infarction. This interventional technique is routinely used in younger patients and less often in the group of the elderly (above 65 to 70 years of age).

Aim: The authors tried to answer the following questions:

1. Are there any differences in the primary PTCA technique between the younger patients and the elderly?

2. Are the elderly patients really at high cardiovascular risk?

3. Are there any differences in primary angiographical results between the two groups?

4. Are there any differences in the clinical in-hospital follow-up?

5. Will the results be introduced into practice?



Methods: A prospective analysis of 116 consecutive patients with acute ST-elevation myocardial infarction who were treated with primary PCI in the period from January 2000 to the end of December 2000. In 89 cases (76.6 %) at least one coronary stent was implanted into the infarction related artery and in 27 cases (23.7 %) the balloon angioplasty only was done. The whole group of patients at the age 65.4 on average (38–96 years old) was divided into two groups: 41 patients (35.3 %) at the age of 70 and more (74.8 ± 4.9) created group A and 75 (64.7 %) younger patients (56 ± 8.5 years) created group B. After that both groups were statistically compared according to their in-hospital occurrence of the combined clinical end-point (mortality, reinfarction and target vessel revascularization). The followed factors were observed more often in group A: diabetes mellitus (< 0.0001), presence of clinical significant ischemic lower extremities disease (p = 0.002) and there were more women (p = 0.032). Conversely more younger patients were smokers (p = 0.0001), more patients had positive family histories (p = 0.032) and acute myocardial infarction as the first sign of ischemic heart disease (p = 0.048).

Results: The elderly patients in group A had significantly higher number of diseased coronary arteries (p = 0.001), more of them were in cardiogennic shock (Killip IV, p = 0.041) and there was more often the need for artificial ventilation (p = 0.015). The other followed factors during hospitalization did not differ, but a strong trend to the higher need of the intraaortic balloon counterpulsation insertion (p = 0.052) and lower primary success of coronary intervention was observed (p = 0.13), where the technical procedural difficulties reflected in the trend of longer „needle to balloon“ time interval (p = 0.14). Younger patients in group B were more often hemodynamically stable without the presence of congestive heart failure (Killip I, p = 0.001). The combined in-hospital clinical end-point was achieved in 11 patients (14.6 %) in group A and in 1 patient (1.3 %) in group B (p = 0.02). This statistically significant difference was due to higher mortality in the elderly (14.6 % vs. 0 %, p < 01).

Conclusion: The paper proved success and relative safety of the mechanical reperfusion treatment in the elderly at the age of 70 and more. The high cardiovascular risk was reflected in higher in-hospital mortality in this group of patients.

Keywords: primary coronary intervention, acute myocardial infarction, elderly.