Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jan 21:10:321-7.
doi: 10.2147/CIA.S74012. eCollection 2015.

Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy

Berglind Libungan  1 , Thomas Karlsson  2 , Per Albertsson  1 , Johan Herlitz  3
Affiliations

Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy

Berglind Libungan et al. Clin Interv Aging. .

Abstract

Background: There are limited data on patients aged >75 years with myocardial infarction (MI), especially those who are treated conservatively.

Hypothesis: There are important differences in the clinical characteristics and outcome between elderly MI patients selected for invasive or conservative treatment strategy.

Methods: A total of 1,413 elderly patients (>75 years old) admitted to Sahlgrenska University Hospital, Gothenburg, Sweden with a final diagnosis of acute MI in 2001 or 2007, were divided into two groups, those who underwent a conservative treatment strategy (conservative group [CG], n=1,169) and those who underwent coronary angiography and were revascularized if indicated (invasive group [IG], n=244).

Results: Other than higher age in the CG, there were no significant differences in traditional risk factors such as hypertension, diabetes, and smoking in the two groups. A higher proportion of patients in the CG had a history of heart failure and cerebrovascular disease. The hazard ratio (with 95% confidence interval), adjusted for potential confounders, for 5 year mortality in the IG in relation to the CG was 0.49 (0.39, 0.62), P<0.0001. Overall, in the elderly with MI, the proportion who underwent an invasive treatment strategy doubled from 12% in 2001 to 24% in 2007, despite a slightly higher mean age.

Conclusion: Elderly patients with MI in the CG (no coronary angiography), were generally older and a higher proportion had chronic diseases such as congestive heart failure and cerebrovascular disease than those in the IG. Our data suggest that the invasive treatment strategy is associated with better outcome. However, randomized trials will be needed to determine whether revascularization procedures are beneficial in elderly patients with MI, in terms of less symptoms, better outcome, and improved quality of life.

Keywords: acute coronary syndrome; aged; elderly; myocardial infarction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan-Meier curve describing survival in elderly patients with MI related to treatment strategy group. Abbreviation: MI, myocardial infarction.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Savonitto S, Cavallini C, Petronio AS, et al. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv. 2012;5(9):906–916. - PubMed
    1. Kinnaird TD, Stabile E, Mintz GS, et al. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. Am J Cardiol. 2003;92(8):930–935. - PubMed
    1. Gao L, Hu X, Liu YQ, Xue Q, Feng QZ. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction. Clin Interv Aging. 2014;9:1241–1246. - PMC - PubMed
    1. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet. 1999;354(9180):708–715. No authors listed. - PubMed
    1. Fox KA, Poole-Wilson PA, Henderson RA, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: The British Heart Foundation RITA 3 randomised trial. Lancet. 2002;360(9335):743–751. - PubMed