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. 2015 Sep;23(10):477-482.
doi: 10.1007/s12471-015-0733-2.

Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly

Bimmer E P M Claessen  1 , Wouter J Kikkert  2 , Loes P Hoebers  2 , Hassina Bahadurzada  2 , Marije M Vis  2 , Jan Baan  2 , Karel T Koch  2 , Robbert J de Winter  2 , Jan G P Tijssen  2 , Jan J Piek  2 , José P S Henriques  2
Affiliations

Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly

Bimmer E P M Claessen et al. Neth Heart J. 2015 Sep.

Abstract

Background: The population is ageing rapidly and the proportion of patients aged ≥ 80 years undergoing primary percutaneous coronary intervention (PCI) is rising, but clinical trials have primarily been performed in younger patients.

Methods: Patients undergoing primary PCI between 2003 and 2008 were subdivided into 3 groups: < 60, 60-79, and ≥ 80 years. Endpoints at 3-year follow-up included all-cause mortality, recurrent myocardial infarction (reMI), stent thrombosis, target lesion revascularisation (TLR), bleeding (BARC bleeding ≥ 3), stroke, and major adverse cardiovascular events (MACE, a composite of cardiac mortality, reMI, stroke and TLR).

Results: 2002 patients with ST-segment elevation myocardial infarction (STEMI) were included, 885 (44.2 %) aged < 60, 921 (46.0 %) 60-79, and 196 (9.7 %) ≥ 80 years. Comorbidities such as diabetes mellitus, prior stroke, malignant disease, anaemia, and chronic kidney disease were more prevalent in patients ≥ 80 years. The incidence of both ischaemic and bleeding events strongly increased with age. Age ≥ 80 years was an independent predictor of mortality (HR 2.56, 95 % CI1.69-3.87, p < 0.001), a borderline non-significant predictor of overall bleeding (HR 1.38, 95 %CI 0.95-2.00, p = 0.088), and a significant predictor of non-access site bleeding (HR 2.26, 95 %CI 1.46-3.51, p < 0.001).

Conclusion: Patients ≥ 80 years experienced high rates of ischaemic and bleeding complications; especially in this high-risk patient group individualised therapy is needed to optimise clinical outcomes.

Keywords: Acute myocardial infarction; Elderly; Primary percutaneous coronary intervention; Stent.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier curve for major adverse cardiac events
Fig. 2
Fig. 2
Kaplan-Meier curve for recurrent myocardial infarction, mortality, BARC bleeding ≥ 3, and stroke. BARC bleeding academic research consortium
Fig. 3
Fig. 3
Probability of 3-year mortality, major adverse cardiac events, stroke, and BARC bleeding ≥ 3 according to age. MACE major adverse cardiovascular event, BARC bleeding academic research consortium
See this image and copyright information in PMC

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