Heart and Vessels

, Volume 29, Issue 1, pp 15–20

Impact of advanced age on myocardial perfusion, distal embolization, and mortality patients with ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb–IIIa inhibitors

  • Giuseppe De Luca
  • Arnoud W. J. van’t Hof
  • Kurt Huber
  • C. Michael Gibson
  • Francesco Bellandi
  • Hans-Richard Arntz
  • Mauro Maioli
  • Marko Noc
  • Simona Zorman
  • Gioel Gabrio Secco
  • Uwe Zeymer
  • H. Mesquita Gabriel
  • Ayse Emre
  • Donald Cutlip
  • Tomasz Rakowski
  • Maryann Gyongyosi
  • Dariusz Dudek
Original Article

DOI: 10.1007/s00380-013-0323-4

Cite this article as:
De Luca, G., van’t Hof, A.W.J., Huber, K. et al. Heart Vessels (2014) 29: 15. doi:10.1007/s00380-013-0323-4

Abstract

Despite mechanical reperfusion, the outcome is still unsatisfactory in elderly patients with ST-segment elevation myocardial infarction (STEMI). The vast majority of studies have been conducted without extensive use of glycoprotein (Gp) IIb–IIIa inhibitors, which have been associated with improved perfusion and survival. Thus the aim of the current study was to evaluate the impact of age on the angiographic and clinical outcome patients with STEMI undergoing primary angioplasty with Gp IIb–IIIa inhibitors. Our population is represented by a total of 1,662 patients undergoing primary angioplasty for STEMI included in 11 randomized trials comparing early versus late administration of Gp IIb–IIIa inhibitors. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty. A total of 231 (13.9 %) patients were older than 75 years. Elderly patients showed a larger prevalence of female gender, hypertension, and diabetes, more advanced Killip class at presentation and longer time to treatment, but a smaller prevalence of smoking. All patients were treated with GP IIb–IIIa inhibitors. Elderly patients showed a significantly impaired postprocedural thrombolysis in myocardial infarction (TIMI) flow (TIMI 0–2: 17.7 vs 10.3 %, P = 0.002) and myocardial perfusion (myocardial blush grade 0–1: 38.3 vs 26.5 %, P = 0.001), and higher prevalence of distal embolization (19.2 vs 9.8 %, P < 0.001), whereas no difference was observed in terms of ST-segment resolution. At follow-up, elderly patients showed a significantly higher mortality (3.2 vs 11.0 %, hazard ratio (HR) (95 % confidence interval (CI)) = 3.78 (2.31–6.16), P < 0.001), which was confirmed after adjustment for baseline confounding factors (HR (95 % CI) = 5.01 (2.63–9.55), P < 0.0001). This study showed that among patients with STEMI undergoing primary angioplasty, advanced age is an independent predictor of mortality after primary angioplasty. Higher rates of distal embolization and poor myocardial perfusion, in addition to the worse risk profile, contribute toward explaining the impact of aging on mortality.

Keywords

Primary angioplastyPerfusionElderlyMortality

Copyright information

© European Union 2013

Authors and Affiliations

  • Giuseppe De Luca
    • 1
  • Arnoud W. J. van’t Hof
    • 2
  • Kurt Huber
    • 3
  • C. Michael Gibson
    • 4
  • Francesco Bellandi
    • 5
  • Hans-Richard Arntz
    • 6
  • Mauro Maioli
    • 5
  • Marko Noc
    • 7
  • Simona Zorman
    • 7
  • Gioel Gabrio Secco
    • 1
  • Uwe Zeymer
    • 8
  • H. Mesquita Gabriel
    • 9
  • Ayse Emre
    • 10
  • Donald Cutlip
    • 11
  • Tomasz Rakowski
    • 12
  • Maryann Gyongyosi
    • 13
  • Dariusz Dudek
    • 12
  1. 1.Division of Cardiology“Maggiore della Carità” Hospital, Eastern Piedmont UniversityNovaraItaly
  2. 2.Division of CardiologyHospital “De Weezenlanden”ZwolleThe Netherlands
  3. 3.Department of Medicine (Cardiology and Emergency Medicine)WilhelminenspitalViennaAustria
  4. 4.TIMI Study Group, Cardiovascular DivisionBrigham and Women’s HospitalBostonUSA
  5. 5.Division of CardiologyPrato HospitalPratoItaly
  6. 6.Medizinische Klinik II, Kardiologie/Pulmologie, CharitéBerlinGermany
  7. 7.Center for Intensive Internal MedicineUniversity Medical CenterLjubljanaSlovenia
  8. 8.Division of CardiologyHerzzentrum LudwigshafenLudwigshafenGermany
  9. 9.Division of CardiologyHospital de Santa MariaLisbonPortugal
  10. 10.Siyami Ersek Thoracic and Cardiovascular Surgery CenterIstanbulTurkey
  11. 11.Interventional Cardiology SectionBeth Israel Deaconess Medical CenterBostonUSA
  12. 12.Second Department of CardiologyInstitute of Cardiology, Jagiellonian UniversityKrakowPoland
  13. 13.Department of CardiologyMedical University of ViennaViennaAustria