Characteristics and prognosis of coronary revascularization procedure in patients age 80 and older presenting with acute myocardial infarction

Abstract

Background: Elderly patients are underrepresented in randomized trials evaluating strategies of early coronary revascularization in acute myocardial infarction (MI), whereas in real life octogenarians represent the fastest-growing segment of our population. We sought to describe the characteristics and outcome of patients > or = 80 years referred to a catheterization laboratory for MI.

Material/methods: We studied 1687 consecutive patients referred to our cath-laboratory for MI, divided into 2 groups: group 1 patients aged > or =80 years (n=152) and group 2 (<80 years, [n=1535]). Baseline clinical and angiographic characteristics and mortality were studied.

Results: Cardiogenic shock and three-vessel disease were more frequent in the patients > or =80 years (p<0.0001). Angiographic success of percutaneous coronary interventions was high in elderly patients (89.5%), but was significantly lower as compared to group 2 (p<0.0001). In-hospital mortality was 18% in group 1 versus 5.5% in group 2 (p<0.0001). No patient from group 1 presenting anterior MI with cardiogenic shock survived. The rate of mortality in group 1 between the end of hospitalization and one year following MI was only 4% (versus 3% in group 2, p=0.58). Long-term prognosis of elderly patients was similar as compared to expected survival of subjects > or =80 years.

Conclusions: This study demonstrates that the angiographic characteristics of patients > or =80 years are significantly different, associated with an initial increased risk of mortality, and that prognosis of MI is excellent once the acute phase has passed.