Primary percutaneous coronary intervention for acute myocardial infarction in elderly aged 75 years and over: in-hospital mortality and clinical outcome

OBJECTIVES
We aimed to determine the in-hospital mortality and clinical outcome of patients older than 75 years who were admitted to our high-volume tertiary center with ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous intervention (PCI).

STUDY DESIGN
Our study included patients over 75 years old who were admitted with STEMI and underwent primary PCI at our center between January 2008 and September 2011. We retrospectively collected data from our hospital records for 1165 patients with STEMI. We found 186 patients that were eligible for our study. We defined major adverse cardiovascular events (MACE) as in-hospital mortality, repeated target vessel revascularization, and reinfarction.

RESULTS
The mean age of the patients was 79.7±4.4 years and the mean pain-balloon inflation time was 4.7±2.3 hours. The procedure success rate was 71.5%. In-hospital mortality and MACE occurred in 20.4% and 25.8% of patients, respectively. Twenty patients had cardiogenic shock at admission. Patients with cardiogenic shock had significantly more MACE than the rest of the study population (76.5% vs. 17.5%, p<0.0001). Independent predictors of MACE included Killip class at admission (OR 4.98, 95% CI 1.25-19.8, p=0.02), white blood cell counting (OR 1.15, 95% CI 1.0-1.3, p=0.04), development of in-hospital heart failure (OR 3.34, 95% CI 1.07-10.58, p=0.04), the presence of atrioventricular block in the hospital (OR 3.98, 95% CI 1.09-14.5, p=0.04), and the TIMI flow rate after primary PCI (OR 3.42, 95% CI 1.19-10.76, p=0.04).

CONCLUSION
Our study revealed a high rate of MACE in patients older than 75 years admitted with STEMI regardless of undergoing primary PCI.