Author + information
- Martín Valdebenito1,
- Dante Lindefjeld1,
- Nicolás Veas2,
- José Luis Winter2,
- Manuel Méndez1,
- Osvaldo Pérez1,
- Gonzalo Martínez1 and
- Alejandro Martínez1
The microvascular reperfusion (MR) is closely related to morbidity and mortality in acute myocardial infarction (AMI) treated with primary angioplasty (PA). It is uncertain the result of MR in elderly patients treated with PA.
To compare the characteristics of the MR after to perform a PA among patients > 75 years versus younger.
An observational analytic study, retrospective cohort. Were evaluated all AMI treated with PA in Dr. Sotero del Rio Hospital between June 2013 and July 2014. We compared the clinical, angiographic characteristics and mortality in the follow-up among younger versus older patients ( > 75 years).
Among 316 patients with AMI treated with PA in this period, 48 patients (15%) were aged > 75 years. Compared to <75 years (268 patients) the elderly had a higher prevalence of hypertension (91.7% vs 59.3%; p < 0.05), less history of smoking (16.7% vs 55.2%; p 50%, 37.5% vs 46.5%; p = 0.2). There were differences, however, as to the culprit artery and the number of diseased vessels: In the elderly the culprit artery was mainly the right coronary artery (54.2% vs 15.3%; p 2 vessels disease (70.8% vs 52.6%; p < 0.05). Cardiovascular mortality (CV) per year was higher in the elderly (16.7% vs 6%, p = 0.01). In the post-AP analysis there was no difference in the final epicardial flow (TIMI 3 flow 70.8% vs 78.4%; p = 0.16), however, was a worse MR measured by a blush 3 of 60.4% vs 79.1% p < 0.05; Final TIMI frame count (CTFC) 32.3 +/- 11 vs. 23.9 +/- 7 p <0.05 and less successful reperfusion (cTIMI 75 (OR = 7.2 CI 3.3-16, p <0.001), pre-dilatation (OR = 2.8 CI 1.6-4.9, p <0.001) and thrombus aspiration (OR = 2.95 CI 1.74-5.0 p <0.001).
Microvascular reperfusion post PA is worse in elderly (exacerbated during the pre-dilatation and aspiration of thrombus in the culprit vessel) despite having a similar SYNTAX score and final epicardial flow. This suggests caution in deciding complete revascularization (multivessel) during an AP in elderly patients and invites develop new treatment strategies of MR in this risk group.