Background: The aim of the present study was to assess the early clinical outcome following primary coronary angioplasty in elderly patients (aged > or = 75 years) compared to younger patients (< 75 years).
Methods: The study population included 655 consecutive patients (mean age 61.5 +/- 12.4 years) with acute ST-elevation myocardial infarction (MI) who underwent primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Elderly patients accounted for 14.5% (96 of 655) of all patients. Primary PCI was performed using a balloon and/or coronary stent as well as glycoprotein IIb/IIIa inhibitors. The primary endpoint was the in-hospital incidence of major adverse cardiac events (including death, stroke, reinfarction, target vessel revascularization and new onset of heart failure).
Results: Elderly patients were more frequently female (48 vs 20%, p < 0.001) and had more comorbid disease (prior stroke 7.2 vs 2.5%, p < 0.05) and more extensive cardiovascular disease (previous acute MI 13.5 vs 5.5%, p < 0.05; multivessel disease 71.8 vs 44.6%, p < 0.0005) and a significantly lower ejection fraction (48 vs 50%, p < 0.05). Despite a similar rate of TIMI 0-1 flow at presentation (69 vs 74%, p = NS), a similar use of stents (84 vs 86%, p = 0.3) and of glycoprotein IIb/IIIa inhibitor infusion (19.8 vs 22.1%, p = 0.3) and a comparable angiographic residual stenosis (21 vs 19%, p = NS), the final rate of TIMI 3 flow was significantly lower in the elderly population (77.8 vs 91.4%, p < 0.001). Although the in-hospital ischemic event rates for all ages were not significantly different, the in-hospital mortality was higher in the elderly as compared with younger patients (9.3 vs 3.2%, p < 0.0001), even when the patients with cardiogenic shock at the time of admission were excluded (4.4 vs 0.9%, p < 0.0001). Furthermore, more patients aged > or = 75 had in-hospital heart failure (5.2 vs 1.8%, p < 0.05). In the whole population, multivariate analysis identified baseline Killip class III-IV as the only independent predictor of events. In elderly patients, multivariate analysis identified baseline Killip class III-IV and the time from the onset of chest pain to PCI as independent predictors of events.
Conclusions: Our data suggest that in elderly patients with acute ST-elevation MI primary PCI yields positive results: successful reperfusion can be achieved in a high proportion of elderly patients and the mortality rates are lower, than those reported in non-PCI registries. A high Killip class and late reperfusion therapy predict an unfavorable outcome in elderly patients treated with primary PCI.