Author + information
- Lucas Christianson,
- Leonardo Clavijo,
- David Shavelle,
- Michael Gaglia,
- Ray Matthews and
- Anhilkumara Mehra
Acute myocardial infarction has a higher prevalence in elderly patients however they are underrepresented in clinical trials.
The goal of the study is to investigate baseline risk factors, interventional characteristics and hospital outcomes in elderly patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
Retrospective analysis of 1309 patients treated with PCI for acute myocardial infarction (AMI) at the Los Angeles County Hospital + USC Medical Center and Keck Medical Center of USC between January 2008 and June 2014. Patients were divided into 2 groups: age greater than 75 years (group A) and age 75 years or less (group B).
Group A had higher in-hospital morbidity (23.33% vs. 16.13% P=0.03) and mortality (20.67% vs. 3.71% P<0.0001). Hospitalizations and intensive care unit stays were longer (9.67±14.68 days vs. 5.70±7.30 days P=0.002) and (5.99±8.23 days vs. 4.16±5.46 days P=0.04), respectively. Post-cardiac catheterization group A had more acute renal insufficiency (12.67% vs. 3.62% P<0.0001) and cerebral vascular accidents (2.67% vs. 0.69% P=0.04). There was no difference in bleeding complications between the two groups. Although, group A was more likely to require intra-aortic balloon pump support (27.33% vs. 13.11% P<0.0001); they were less likely to receive glycoprotein IIb/IIIa inhibitors (20.0% vs. 29.59% P=0.01), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (49.33% vs. 72.30% P<0.0001), and beta-blockers (66.67% vs. 83.26% P=0.03).
Despite advancements in PCI and the adjuvant management of AMI, advanced age remains an important predictor of procedural complications and is associated with a seven-fold increase risk of in-hospital death. Elderly patients are less likely to receive angiotensin inhibition and beta-blockers after AMI, which may also impact their long-term outcome. Future studies designed to investigate and optimize the management of AMI in elderly patients are needed.