Outcomes of Elderly Patients With Acute Myocardial Infarction and Heart Failure Who Undergo Percutaneous Coronary Intervention

Abstract

Background: As life expectancy rises, percutaneous coronary intervention (PCI) is being performed more frequently, even in elderly patients with acute myocardial infarction (AMI). This study evaluated outcomes of elderly patients with AMI complicated by heart failure (AMIHF), as defined by Killip Class ≥2 at admission, who undergo PCI. Methods and Results: We retrospectively analyzed 185 patients with AMIHF aged ≥80 years (median age 85 years) who underwent PCI between 2009 and 2019. The median follow-up period was 572 days. The rates of in-hospital major bleeding (Bleeding Academic Research Consortium Type 3 or 5) and in-hospital all-cause mortality were 20.5% and 25.9%, respectively. The proportion of frail patients increased during hospitalization, from 40.6% at admission to 59.2% at discharge (P<0.01). The cumulative incidence of all-cause mortality was 36.3% at 1 year and 44.1% at 2 years. After adjusting for confounders, advanced age, Killip Class 4, final Thrombolysis in Myocardial Infarction flow grade <3, and longer door-to-balloon time were associated with higher mortality, whereas higher left ventricular ejection fraction and cardiac rehabilitation were associated with lower mortality (all P<0.05). Progression of frailty during hospitalization was an independent risk factor for long-term mortality in hospital survivors (P<0.01). Conclusions: The management of patients with AMIHF aged ≥80 years who undergo PCI remains challenging, with high rates of in-hospital major bleeding, frailty progression, and mortality.

Keywords: Acute myocardial infarction; Elderly; Frailty; Heart failure; Percutaneous coronary intervention.

Figure 1.

Study flowchart. AMI, acute myocardial infarction; AMIHF, acute myocardial infarction complicated by heart failure; PCI, percutaneous coronary intervention.

Figure 2.

(A) In-hospital major bleeding rate and in-hospital mortality. (B) Change in frailty status during hospitalization. BARC, Bleeding Academic Research Consortium.

Figure 3.

Kaplan-Meier curve for all-cause mortality in patients with acute myocardial infarction complicated by heart failure aged ≥80 years.

Figure 4.

Kaplan-Meier curves for all-cause mortality in patients with acute myocardial infarction complicated by heart failure aged ≥80 years according to frailty progression status during hospitalization.