open access

Vol 68, No 8 (2010)
Original articles
Published online: 2010-08-21
Submitted: 2012-12-28
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Benefits from revascularisation therapy in the elderly with acute myocardial infarction. Comparative analysis of patients hospitalised in 1992-1996 and in 2005-2006

Anna Polewczyk, Marianna Janion, Mariusz Gąsior, Marek Gierlotka, Lech Poloński
Kardiol Pol 2010;68(8):873-881.

open access

Vol 68, No 8 (2010)
Original articles
Published online: 2010-08-21
Submitted: 2012-12-28

Abstract


Background: Coronary artery disease in the elderly is associated with multilevel atherosclerosis and chronic co-morbidities.
Aim: To determine benefits from revascularisation in the elderly.
Methods: A total of 830 patients over 65 years with ST-segment elevation myocardial infarction (STEMI) were included. Of them, 339 admitted in 1992-1996 (38.5% STEMI population hospitalised in 1992-1996) (group 1) and 491 (55.2% STEMI population) admitted in 2005-2006 (group 2) were compared. We examined patient characteristics, the course of hospitalisation, the type of therapy and its effect on in-hospital and long-term prognosis (6-month follow-up).
Results: The proportion of patients over 65 has increased significantly from 38.5% in 1992-1996 to 55.2% in 2005-2006 (p < 0.001). In 1992-1996 fibrinolysis was administered in 11.2% of patients while 88.8% received conservative treatment. In 2005-2006 reperfusion therapy was used in 52.2% of patients (15.1% fibrinolysis, 37.1% primary angioplasty). The in-hospital and 6-month mortality tended to be lower in the more recent group (21.5% v. 18.5% and 28% v. 23.8%, NS, respectively). In group 1 there were 22.6% of deaths among those receiving conservative treatment versus 13.2% in patients submitted to reperfusion (p = 0.18). In group 2 in-hospital mortality was the lowest in patients undergoing invasive treatment which was associated with a 62% decrease in 6-month mortality as compared with those receiving conservative treatment (p < 0.001).
Conclusions: Invasive treatment significantly improves in-hospital and long-term survival in older patients with STEMI. Lack of mortality reduction was related to worse clinical presentation of the currently hospitalised older patient.
Kardiol Pol 2010; 68, 8: 873-881

Abstract


Background: Coronary artery disease in the elderly is associated with multilevel atherosclerosis and chronic co-morbidities.
Aim: To determine benefits from revascularisation in the elderly.
Methods: A total of 830 patients over 65 years with ST-segment elevation myocardial infarction (STEMI) were included. Of them, 339 admitted in 1992-1996 (38.5% STEMI population hospitalised in 1992-1996) (group 1) and 491 (55.2% STEMI population) admitted in 2005-2006 (group 2) were compared. We examined patient characteristics, the course of hospitalisation, the type of therapy and its effect on in-hospital and long-term prognosis (6-month follow-up).
Results: The proportion of patients over 65 has increased significantly from 38.5% in 1992-1996 to 55.2% in 2005-2006 (p < 0.001). In 1992-1996 fibrinolysis was administered in 11.2% of patients while 88.8% received conservative treatment. In 2005-2006 reperfusion therapy was used in 52.2% of patients (15.1% fibrinolysis, 37.1% primary angioplasty). The in-hospital and 6-month mortality tended to be lower in the more recent group (21.5% v. 18.5% and 28% v. 23.8%, NS, respectively). In group 1 there were 22.6% of deaths among those receiving conservative treatment versus 13.2% in patients submitted to reperfusion (p = 0.18). In group 2 in-hospital mortality was the lowest in patients undergoing invasive treatment which was associated with a 62% decrease in 6-month mortality as compared with those receiving conservative treatment (p < 0.001).
Conclusions: Invasive treatment significantly improves in-hospital and long-term survival in older patients with STEMI. Lack of mortality reduction was related to worse clinical presentation of the currently hospitalised older patient.
Kardiol Pol 2010; 68, 8: 873-881
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Keywords

myocardial infarction; elderly; reperfusion strategy; prognosis

About this article
Title

Benefits from revascularisation therapy in the elderly with acute myocardial infarction. Comparative analysis of patients hospitalised in 1992-1996 and in 2005-2006

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 68, No 8 (2010)

Pages

873-881

Published online

2010-08-21

Bibliographic record

Kardiol Pol 2010;68(8):873-881.

Keywords

myocardial infarction
elderly
reperfusion strategy
prognosis

Authors

Anna Polewczyk
Marianna Janion
Mariusz Gąsior
Marek Gierlotka
Lech Poloński

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