Skip to main content
SpringerLink
Log in

Efficacy of Coronary Angioplasty on Long-Term Outcome in Elderly Chinese Patients with ST Elevated Myocardial Infarction

  • Original Paper
  • Published:
Cell Biochemistry and Biophysics Aims and scope Submit manuscript

Abstract

The benefit and efficacy of interventional coronary therapies in elderly patients is still a controversial subject, especially in parts of the world where traditional and conservative medicine is still mainstream. In China, the benefit of intervention is still questionable, hence, this study investigated the prognostic significance of coronary angioplasty on outcomes of elderly patients presenting with ST-segment elevated myocardial infarction (STEMI). The study cohort comprised of 270 elderly (age ≥ 75 years) patients who had confirmed STEMI. Some 116 patients underwent coronary angioplasty (called CA group) and their prognoses and survival over the short- and long-term periods (up to 80 months) were compared to 154 comparable patients who received a noninvasive, more conservative medical therapy (non-CA group). The subsequent Kaplan–Meier survival curves and statistical analyses were used to ascertain any difference between the groups. There was no significant differences between the two groups in terms of their clinical presentation, clinical risk, cardiac features, medications and medical procedures, except that the peak creatine kinase was significantly higher in the CA group. The success rate of interventional percutaneous coronary intervention observed in the CA group was 92.4% and during the hospitalization period, there were fewer deaths in the CA group (11 vs. 61 in the non-CA group). Furthermore, after 1-year and up to 7 years postsurgery, the CA group had a significant survival when compared to the non-CA cohort. Analysis of the longer-term data, using multivariate Cox regression analysis after 80 months indicated a hazard ratio of mortality for patients in CA group to be 0.283 (95% CI: 0.140–0.534, P < 0.001). Also, multivariate logistic regression analysis identified conservative treatment, chronic renal failure, cardiac arrhythmia, chronic lung disease and left ventricular ejection fraction, as predictors of higher long-term mortality in elderly patients with STEMI. In conclusion, this study clearly indicates that elderly Chinese patients with STEMI who undergo coronary angioplasty benefit and have a better survival rates in both the short- and long-term.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Alexander, K. P., Galanos, A. N., Jollis, J. G., et al. (2001). Postmyocardial infarction risk-stratification in elderly patients. American Heart Journal, 142, 37–42.

    Article  CAS  PubMed  Google Scholar 

  2. Guagliumi, G., Stone, G. W., Cox, D. A., et al. (2004). Outcome in elderly patients undergoing primary coronary intervention for ST elevated myocardial infarction. Results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. Circulation, 110, 1598–1604.

    Article  PubMed  Google Scholar 

  3. Stern, S., Behar, S., Leor, J., et al. (2004). Presenting symptoms, admission electrocardiogram, management, and prognosis in acute coronary syndromes: Differences by age. American Journal of Geriatric Cardiology, 13, 188–196.

    Article  PubMed  Google Scholar 

  4. Yan, R. T., Yan, A. T., Tan, M., et al. (2006). Age-related differences in the management and outcome of patients with acute coronary syndromes. American Heart Journal, 151(2), 352–359.

    Article  PubMed  Google Scholar 

  5. MacDonald, P., Johnstone, D., & Rockwood, K. (2000). Coronary artery bypass surgery for elderly patients: Is our practice based on evidence or faith? Canadian Medical Association Journal, 162, 1005–1006.

    CAS  PubMed  Google Scholar 

  6. Halon, D. A., Adawi, S., Dobrechy-Mery, I., et al. (2004). Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients. Journal of the American College of Cardiology, 43, 346–352.

    Article  PubMed  Google Scholar 

  7. Harpaz, D., Rozenman, Y., Behar, S., et al. (2007). Coronary angiography in the elderly with ST elevated myocardial infarction. International Journal of Cardiology, 116, 249–256.

    Article  PubMed  Google Scholar 

  8. De Gregorio, J., Kobayashi, Y., Albiero, R., et al. (1998). Coronary artery stenting in the elderly: Short-term outcome and long-term angiographic and clinical follow-up. Journal of the American College of Cardiology, 32, 577–583.

    Article  PubMed  Google Scholar 

  9. Wennberg, D. E., Malenka, D. J., Sengupta, A., et al. (1999). Percutaneous transluminal angioplasty in the elderly: Epidemiology, clinical risk factors, and in-hospital outcomes. American Heart Journal, 137, 639–645.

    Article  CAS  PubMed  Google Scholar 

  10. Nasser, T. K., Fry, E. T., Annan, K., et al. (1997). Comparison of six-month outcome of coronary artery stenting in patients < 65, 65–75, and >75 years of age. American Journal of Cardiology, 80, 998–1001.

    Article  CAS  PubMed  Google Scholar 

  11. Morrison, D. A., Bies, R. D., & Sacks, J. (1997). Coronary angioplasty for elderly patients with “high risk” unstable angina: Short-term outcomes and long-term survival. Journal of the American College of Cardiology, 29, 339–344.

    Article  CAS  PubMed  Google Scholar 

  12. Valente, S., Lazzeri, C., Salvadori, C., et al. (2008). Effectiveness and safety of routine primary angioplasty in patient’s aged ≥85 years with ST elevated myocardial infarction. Circulation Journal, 72, 67–70.

    Article  PubMed  Google Scholar 

  13. Graham, M. M., Ghali, W. A., Faris, P. D., et al. (2002). Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) Investigators: Survival after coronary revascularization in the elderly. Circulation, 105, 2378–2384.

    Article  PubMed  Google Scholar 

  14. Shen, J. Y., He, B., Liu, J. P., et al. (2005). Percutaneous coronary intervention and treatment effects on patients with ischemic coronary artery disease aged ≥75 years. Chinese Journal of Interventional Cardiology, 13(6), 367–370.

    Google Scholar 

  15. Smith, S. C., Jr., Feldman, T. E., Hirshfeld, J. W., Jr., et al. (2006). 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, 113(7), e166–e286.

    Article  PubMed  Google Scholar 

  16. Mehta, R. H., O’Neill, W. W., Harjai, K. J., et al. (2006). Prediction of one-year mortality among 30-day survivors after primary percutaneous coronary interventions, on behalf of the Primary Angioplasty in Myocardial Infarction (PSTEMI) and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. American Journal of Cardiology, 97, 817–822.

    Article  PubMed  Google Scholar 

  17. van der Vleuten, P. A., Rasoul, S., Huurnink, W., et al. (2008). The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention. BMC Cardiovascular Disorders, 8, 4.

    Article  PubMed  Google Scholar 

  18. Vignali, L., Saia, F., Manari, A., et al. (2008). Long-term outcomes with drug-eluting stents versus bare metal stents in the treatment of saphenous vein graft disease (results from the REgistro Regionale AngiopLastiche Emilia-Romagna registry). American Journal of Cardiology, 101(7), 947–952.

    Article  CAS  PubMed  Google Scholar 

  19. Hirakawa, Y., Masuda, Y., Kuzuya, M., et al. (2006). Effect of emergency percutaneous coronary intervention on in-hospital mortality of very elderly (80+ years of age) patients with ST elevated myocardial infarction. International Heart Journal, 47(5), 663–669.

    Article  PubMed  Google Scholar 

  20. Benson, K., & Hartz, A. J. (2000). A comparison of observational studies and randomized, controlled trials. New England Journal of Medicine, 342, 1878–1886.

    Article  CAS  PubMed  Google Scholar 

  21. Concato, J., Shah, N., & Horwitz, R. I. (2000). Randomized, controlled trials, observational studies, and the hierarchy of research designs. New England Journal of Medicine, 342, 1887–1892.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors thank C. Paul Plested, D.Phil., for suggestions and editing.

Author information

Authors and Affiliations

  1. Department of Cardiology, RenJi Hospital, Shanghai JiaoTong University Medical College, No. 1630, Dong Fang Rd, Shanghai, 200127, People’s Republic of China

    JieYan Shen, YongPing Du, Wei Song, JianPing Liu, ShuXuan Jin, Jun Bu & Ben He

Authors
  1. JieYan Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. YongPing Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. JianPing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. ShuXuan Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Bu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ben He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ben He.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shen, J., Du, Y., Song, W. et al. Efficacy of Coronary Angioplasty on Long-Term Outcome in Elderly Chinese Patients with ST Elevated Myocardial Infarction. Cell Biochem Biophys 57, 59–65 (2010). https://doi.org/10.1007/s12013-010-9083-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12013-010-9083-2

Keywords

Search

Navigation