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Short and long term outcomes of primary angioplasty in patients aged 75 years and over

Year 2011, Volume: 38 Issue: 2, 189 - 196, 01.06.2011
https://doi.org/10.5798/diclemedj.0921.2011.02.0013

Abstract

Objectives: The treatment of elderly patients with ST segment elevated myocardial infarction (STEMI) remains controversial. This study aimed to investigate the effects of primary angioplasty in elderly patients on in-hospital and long term major adverse cardiac events (MACE). Materials and methods: From October 2003 to March 2008, we retrospectively enrolled 220 patients aged 75 years and over with STEMI who underwent primary an­gioplasty. Patients\' characteristics, in-hospital and long term events were recorded. Results: Male/Female ratio of patients was 129/91 and mean age was 78.7 ± 3.6 (range, 75-97) years, and 58.6% of male). Of these patients 29.2% were diabetics, 69.8% were hypertensive, 34.4% were smoker and 43.5% were anemic at admission. Anterior myocardial infarction was diagnosed in 52.3% of patients. Mean pain-balloon time was 222 ± 116 minutes. Eighty two (38.2%) of these 220 patients had three-vessel disease and 12 (5.7%) were diagnosed as cardiogenic shock. Procedural success was observed in 79.6% of patients. Heart failure was ob­served 27.7% in hospital and intra aortic pump was used in 14.5% of patients. There was no significant difference between age groups in long term major cardiac events and in hospital mortality. Diabetes, leukocyte count at admission and in hospital heart failure were independent predictors of short term MACE and low hemoglobin level at admission and peak CKMB levels were independent predictors of long term MACE. Conclusions: Primary angioplasty in patients aged 75 years and over seems to be associated with low proce­dural complication, high procedural success, improved short and long term survival.

References

  • Claessen BE, Kikkert WJ, Engstrom AE, et al. Primary per- cutaneous coronary intervention for ST elevation myocar- dial infarction in octogenarians: trends and outcomes. Heart 2010; 96(7): 843-7.
  • White HD, Barbash GI, Califf RM, et al. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occludedcoronary arteries trial. Circulation 1996; 94(12): 1826–33.
  • Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007; 115(11): 2570–89.
  • Antoniucci D, Valenti R, Santoro GM, et al. Systematic pri- mary angioplasty in octogenarian and older patients. Am Heart J 1999; 18(5): 670–4.
  • TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary- artery disease (TIME): A randomised trial. Lancet 2001; 358(8): 951–7.
  • Pfisterer M, Buser P, Osswald S, et al. Trial of Invasive ver- susMedical therapy in Elderly patients (TIME) Investiga- tors. Outcomeof elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized med- ical treatmentstrategy: One-year results of the randomized TIME trial. JAMA 2003; 289(8): 1117–23.
  • Graham MM, Ghali WA, Faris PD, Galbraith PD, Norris CM, Knudtson ML. Alberta Provincial Project for Outcomes As- sessment in Coronary Heart Disease (APPROACH) Inves- tigators. Survival after coronary revascularization in the elderly. Circulation 2002; 105(12): 2378–84.
  • Jeroudi MO, Kleiman NS, Minor ST, et al. Percutaneous- transluminal coronary angioplasty in octogenarians. Ann Intern Med 1990; 113(3): 423–8.
  • Abete P, Ferrara N, Cacciatore F, et al. Angina-induced pro- tection against myocardial infarction in adult and elderly patients: a loss of preconditioning mechanism in the aging heart? J Am Coll Cardiol 1997; 30(8): 947–54.
  • Yaşar AS, Başar N, Kasapkara A, Yüksel İÖ, İpek G, Bilge M. Impact of metabolic syndrome on ST segment resolu- tion after thrombolytic therapy for acute myocardial infarc- tion. Dicle Tıp Dergisi.2010;37(3): 276-82.
  • Wang YC, Hwang JJ, Hung CS, Kao HL, Chiang FT, Tseng CD. Outcome of primary percutaneous coronary interven- tion in octogenarians with acute myocardial infarction. J Formos Med Assoc 2006; 105(4): 451-8.
  • Zimmermann S, Ruthrof S, Nowak K, et al. Outcomes of contemporary interventional therapy of ST elevation in- farction in patients older than 75 Years. Clin Cardiol 2009; 32(1): 87–93.
  • Valente S, Lazzeri C, Salvadori C, et al. Effectiveness and safety of routine primary angioplasty in patients aged ≥85 years with acute myocardial infarction. Circ J 2008; 72(1): 67–70.
  • Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarc- tion. N Engl J Med 1999; 340(9): 1162–8.
  • Holmes DR Jr, Bates ER, Kleiman NS, et al. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-1 trial experience. The GUSTO-1 Investigators. Global Uti- lization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol 1995; 26(5): 668–74.
  • Samadi A, Feuvre Le C, Allali Y, et al. Medium-term sur- vival after primary angioplasty for myocardial infarction complicated by cardiogenic shock after the age of 75 years. Arch Cardiovasc Dis 2008; 101(2): 175–80.
  • Guagliumi G, Stone GW, Cox DA, et al. Outcome in el- derlypatients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late An- gioplasty Complications (CADILLAC) Trial. Circulation 2004; 110(10): 1598-604.

Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları

Year 2011, Volume: 38 Issue: 2, 189 - 196, 01.06.2011
https://doi.org/10.5798/diclemedj.0921.2011.02.0013

Abstract

Amaç: ST-segment yükselmeli miyokart infarktüsü (STY­Mİ) ile başvuran yaşlı hastalarda tedavi konusunda çe­lişkiler mevcuttru. Bu çalışmanın amacı, primer perkütan koroner girişimin (PKG) yaşlı hastalarda, hastane içi ve uzun dönem ters kardiyak olaylar üzerine etkisini araş­tırmaktır. Gereç ve yöntem: Ekim 2003 ile Mart 2008 tarihleri ara­sında primer PKG uygulanan, STYMİ olan 75 yaş ve üstü 220 hasta geriye dönük olarak araştırıldı. Hasta özellikle­ri, hastane içi ve uzun dönem olaylar kaydedildi. Bulgular: Hastaların erkek/kadın oranı 129/91 yaş ortala­ması 78.7 ± 3.6 yıl (aralık, 75-97) idi. Hastaların %29.2\' sin­de diyabet, %69.8\' inde hipertansiyon, %34.4\' ünde siga­ra kullanımı, %43.5\'inde başvuru anında anemi mevcuttu. Hastaların %52.3\'ünde anteriyor miyokard infarktüsü (Mİ) mevcuttu. Ortalama ağrı-balon süresi 222 ± 166 dakika idi. Hastaların%38.2\'sinde üç damar hastalığı, %5.7\'sinde başvuru anında kardiyojenik şok mevcuttu. Tüm hastala­ra ayrım yapılmaksızın primer PKG yapıldı ve işlem başa­rısı %79.6 olarak bulundu. Hastaların %79\'una stent ta­kıldı. Hastane içi kalp yetersizliği hastaların %27.7\'sinde mevcuttu. İntra-Aortik Balon Pump %14.5\'inde kullanıldı. Farklı yaş gruplarındaki hastalar arasında hastane içi ve uzun dönem Major Kardiyak Olumsuz Olay (MKOO) açı­sından fark gözlenmedi. Hastaların %20.9\'unda hastane içi MKOO gözlendi. Diyabet, başvuru anı lölosit sayısı ve hastane içi konjestif kalp yetersizliği olması hastane içi MKOO\'ın bağımsız belirleyicileri idi. Ortalama bir yıl takibi yapılan hastaların (0-53 ay) %28\' inde MKOO gözlendi. Başvuru sırasındaki hemoglobin düşüklüğü ve doruk–CKMB düzeyi uzun dönem takipte MKOO\'nun bağımsız belirleyiciler olarak bulundu. Sonuç: Primer anjiyoplasti STYMİ ile başvuran 75 yaş ve üzeri hastalarda düşük işlem komplikasyon insidansı, yüksek işlem başarısı, yüksek kısa ve uzun dönem sağ kalım ile birlikte görünmektedir.

References

  • Claessen BE, Kikkert WJ, Engstrom AE, et al. Primary per- cutaneous coronary intervention for ST elevation myocar- dial infarction in octogenarians: trends and outcomes. Heart 2010; 96(7): 843-7.
  • White HD, Barbash GI, Califf RM, et al. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occludedcoronary arteries trial. Circulation 1996; 94(12): 1826–33.
  • Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007; 115(11): 2570–89.
  • Antoniucci D, Valenti R, Santoro GM, et al. Systematic pri- mary angioplasty in octogenarian and older patients. Am Heart J 1999; 18(5): 670–4.
  • TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary- artery disease (TIME): A randomised trial. Lancet 2001; 358(8): 951–7.
  • Pfisterer M, Buser P, Osswald S, et al. Trial of Invasive ver- susMedical therapy in Elderly patients (TIME) Investiga- tors. Outcomeof elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized med- ical treatmentstrategy: One-year results of the randomized TIME trial. JAMA 2003; 289(8): 1117–23.
  • Graham MM, Ghali WA, Faris PD, Galbraith PD, Norris CM, Knudtson ML. Alberta Provincial Project for Outcomes As- sessment in Coronary Heart Disease (APPROACH) Inves- tigators. Survival after coronary revascularization in the elderly. Circulation 2002; 105(12): 2378–84.
  • Jeroudi MO, Kleiman NS, Minor ST, et al. Percutaneous- transluminal coronary angioplasty in octogenarians. Ann Intern Med 1990; 113(3): 423–8.
  • Abete P, Ferrara N, Cacciatore F, et al. Angina-induced pro- tection against myocardial infarction in adult and elderly patients: a loss of preconditioning mechanism in the aging heart? J Am Coll Cardiol 1997; 30(8): 947–54.
  • Yaşar AS, Başar N, Kasapkara A, Yüksel İÖ, İpek G, Bilge M. Impact of metabolic syndrome on ST segment resolu- tion after thrombolytic therapy for acute myocardial infarc- tion. Dicle Tıp Dergisi.2010;37(3): 276-82.
  • Wang YC, Hwang JJ, Hung CS, Kao HL, Chiang FT, Tseng CD. Outcome of primary percutaneous coronary interven- tion in octogenarians with acute myocardial infarction. J Formos Med Assoc 2006; 105(4): 451-8.
  • Zimmermann S, Ruthrof S, Nowak K, et al. Outcomes of contemporary interventional therapy of ST elevation in- farction in patients older than 75 Years. Clin Cardiol 2009; 32(1): 87–93.
  • Valente S, Lazzeri C, Salvadori C, et al. Effectiveness and safety of routine primary angioplasty in patients aged ≥85 years with acute myocardial infarction. Circ J 2008; 72(1): 67–70.
  • Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarc- tion. N Engl J Med 1999; 340(9): 1162–8.
  • Holmes DR Jr, Bates ER, Kleiman NS, et al. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-1 trial experience. The GUSTO-1 Investigators. Global Uti- lization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol 1995; 26(5): 668–74.
  • Samadi A, Feuvre Le C, Allali Y, et al. Medium-term sur- vival after primary angioplasty for myocardial infarction complicated by cardiogenic shock after the age of 75 years. Arch Cardiovasc Dis 2008; 101(2): 175–80.
  • Guagliumi G, Stone GW, Cox DA, et al. Outcome in el- derlypatients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late An- gioplasty Complications (CADILLAC) Trial. Circulation 2004; 110(10): 1598-604.
There are 17 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Turgay Işık This is me

Hüseyin Uyarel This is me

Mehmet Ergelen This is me

Gökhan Çiçek This is me

Duygu Ersan Demirci This is me

Mehmet Gül This is me

Ersin Yıldırım This is me

Abdurrahman Eksik This is me

Publication Date June 1, 2011
Submission Date March 2, 2015
Published in Issue Year 2011 Volume: 38 Issue: 2

Cite

APA Işık, T., Uyarel, H., Ergelen, M., Çiçek, G., et al. (2011). Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. Dicle Tıp Dergisi, 38(2), 189-196. https://doi.org/10.5798/diclemedj.0921.2011.02.0013
AMA Işık T, Uyarel H, Ergelen M, Çiçek G, Demirci DE, Gül M, Yıldırım E, Eksik A. Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. diclemedj. June 2011;38(2):189-196. doi:10.5798/diclemedj.0921.2011.02.0013
Chicago Işık, Turgay, Hüseyin Uyarel, Mehmet Ergelen, Gökhan Çiçek, Duygu Ersan Demirci, Mehmet Gül, Ersin Yıldırım, and Abdurrahman Eksik. “Primer Anjiyoplastinin 75 Yaş Ve üstü Hastalarda kısa Ve Uzun dönem sonuçları”. Dicle Tıp Dergisi 38, no. 2 (June 2011): 189-96. https://doi.org/10.5798/diclemedj.0921.2011.02.0013.
EndNote Işık T, Uyarel H, Ergelen M, Çiçek G, Demirci DE, Gül M, Yıldırım E, Eksik A (June 1, 2011) Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. Dicle Tıp Dergisi 38 2 189–196.
IEEE T. Işık, “Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları”, diclemedj, vol. 38, no. 2, pp. 189–196, 2011, doi: 10.5798/diclemedj.0921.2011.02.0013.
ISNAD Işık, Turgay et al. “Primer Anjiyoplastinin 75 Yaş Ve üstü Hastalarda kısa Ve Uzun dönem sonuçları”. Dicle Tıp Dergisi 38/2 (June 2011), 189-196. https://doi.org/10.5798/diclemedj.0921.2011.02.0013.
JAMA Işık T, Uyarel H, Ergelen M, Çiçek G, Demirci DE, Gül M, Yıldırım E, Eksik A. Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. diclemedj. 2011;38:189–196.
MLA Işık, Turgay et al. “Primer Anjiyoplastinin 75 Yaş Ve üstü Hastalarda kısa Ve Uzun dönem sonuçları”. Dicle Tıp Dergisi, vol. 38, no. 2, 2011, pp. 189-96, doi:10.5798/diclemedj.0921.2011.02.0013.
Vancouver Işık T, Uyarel H, Ergelen M, Çiçek G, Demirci DE, Gül M, Yıldırım E, Eksik A. Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. diclemedj. 2011;38(2):189-96.