© Borgis - New Medicine 3/2003, s. 43-44
Marzenna Zielinska1, Krzysztof Kaczmarek1, Andrzej Walczak2, Wlodzimierz Koniarek1
Results of coronary angiography in acute myocardial infarction in the elderly
1 Department of Cardiology, Institute of Cardiology, Medical University of Lodz, Poland
Head: prof. Halina Bolinska-Soltysiak, MD, PhD
2 Department of Cardiovascular Surgery, Institute of Cardiology, Medical University of Lodz, Poland
Head: prof. Janusz Zaslonka, MD, PhD
Summary
Acute myocardial infarction (AMI) is one of the main causes of death in advanced age. There are limited data on coronary angiographic findings in elderly patients with AMI.
Methods: In this study, we analysed clinical characteristics and angiographic findings in elderly patients (aged ?75 years) with AMI, who underwent primary PTCA. All data were compared with those of younger patients (<75 years old).
Results: A total of 924 patients, hospitalised due to AMI, were subjected to retrospective analysis. The patients were divided into 2 groups according to age. Group I (n=92) included patients aged ?75 years (mean age 78.82±3.32 yrs). Group II (n=839) comprised younger patients (mean age 58.1±9.7 yrs). The elderly were more likely to be female (51% vs. 26%, p<0.01) and to have other comorbid illnesses. The elderly were also more likely to have antero-lateral AMI (53% vs. 41.5%, p<0.05). The elderly suffered more often from multi-vessel coronary disease (71.7% vs. 55.6%). PTCA on significant lesions was equally successful in patients from both groups (84.78% vs. 89.9%, NS).
Conclusions: 1. The elderly have a multi-vessel coronary disease more often than younger patients. All the same, single-vessel disease was present in over 25% of elderly patients with AMI. 2. Primary PTCA in the elderly with AMI is safe and as effective in achieving reperfusion as in younger patients.
INTRODUCTION
Acute myocardial infarction (AMI) is one of the main causes of death in advanced age. In-hospital as well as follow-up mortality is significantly higher in elderly patients (patients) than in younger patients, independent of the introduced treatment (1, 2).
In younger patients, the management of choice (confirmed by follow-up observations) in AMI seems to be primary coronary angioplasty (PTCA), with stent implantation and treatment with IIb/IIIa inhibitors (3, 4, 5). The dramatic increase in PTCA has resulted in more frequent use of these procedures in the elderly (6, 7, 8). However, despite these trends, there are limited data about coronary angiographic findings in elderly patients with AMI.
In this study, we analysed clinical characteristics and angiographic findings in elderly patients (aged ?75 years) with AMI, who underwent primary PTCA. All data were compared with those of younger patients (<75 years old).
METHODS
Study group: A group of 924 patients, hospitalized due to AMI, were subjected to retrospective analysis. The criteria for acute myocardial infarction diagnosis were: occurrence of typical coronary pain lasting over 30 min with accompanying changes on the electrocardiogram and/or pathological CK-MB and/or troponin elevation. All patients were eligible for primary PTCA. The patients were divided into 2 groups according to age. Group I included patients aged ?75 years. Group II comprised younger patients.
Invasive therapy: All patients were qualified for emergency coronary angiography. One of the criteria for inclusion into the study group was an elapsed time of not more than 6 hours since the onset of chest pain. In cases of complicated infarction (cardiogenic shock, persistent pain), the time criterion was 12 hours. Coronary angiography was interpreted visually on site by each operator. Left main coronary artery disease was defined as ?50% stenosis in the artery. Stenoses ?70% were considered significant in all other coronary arteries. On the basis of the angiography, PTCA of the infarct related artery (IRA) was undertaken, most frequently with simultaneous stent implantation. PTCA was considered to be effective when TIMI 3 – flow with a residual stenosis of not greater than 30% was obtained. If there were no contraindications, the patients were treated with IIb/IIIa inhibitors after stent implantation.
Statistical analysis: Continuous variables are expressed as mean ±SD. Group comparisons used Student´s T-test or the c2 test, as appropriate. A value of P=0.05 was considered to be statistically significant.
RESULTS
The baseline characteristics of the 92 elderly and the 839 younger patients are presented in Table1. The mean age of the elderly was 78.82±3.32 years. The mean age of the younger patients was 58.1±9.7 years. The elderly were more likely to be female (51% vs. 26%) and to have other comorbid illnesses. The elderly were also more likely to have antero-lateral AMI (53.3% vs. 41.5%).
Table 1. Baseline characteristics.
| | Group I
(elderly patients)
n = 92 | Group II
younger patients)
n = 839 | |
| Age (yrs) | 78.8 ? 3.3 | 58.1 ? 9.7 | P < 0.001 |
| Female | 47 (51%) | 218 (26%) | P < 0.001 |
| STEMI | 91.3% | 93.9% | NS |
| Q-wave AMI | 79.3% | 73.8% | NS |
| Antero-lateral AMI | 53.3% | 41.5% | P < 0.05 |
| Infero-posterior AMI | 46.7% | 58.5% | P < 0.05 |
Invasive treatment: Baseline angiographic data are compared in Table 2. Left main coronary artery disease was uncommon in both groups. The elderly were more likely to have multivessel disease (71.7% vs. 55.6%). However, it should be emphasised that patients in advanced age do not always have multi-vessel disease. Single- vessel disease was observed in over 25% of the patients. One patient did not have atheromatic changes in the coronary arteries. Embolus in the right coronary artery resulted in him having a fully-documented AMI.
Almost all patients from both groups underwent primary PTCA. Angioplasty was successful in 84.8% of the elderly patients and in 89.9% of the younger patients (Table 2).
Table 2. Angiographic characteristics and primary PTCA results.
| | Group I | Group II | |
| 1-vessel | 26.09% | 43.1% | P < 0.001 |
| 2-vessel | 32.61% | 28.7% | NS |
| 3-vessel | 39.13% | 26.9% | P < 0.001 |
| Normal vessel | 2.1% | 1% | NS |
| Successful PTCA | 84.78% | 89.98% | NS |
| Stent deployment | 75% | 79.5% | NS |
DISCUSSION
The population of elderly people is characterised by more advanced atheromatosis, and thus more frequently suffers from coronary artery disease. Moreover, this population is more severely burdened with risk factors (2, 5). It should be expected that the elderly almost always have multi-vessel coronary disease. In our study we proved that very often (more than 25%) elderly patients have only single-vessel disease. These patients often have major benefit from primary angioplasty.
We report that, with appropriate case selection, coronary angiography and primary PTCA in the elderly can be performed with high rates of procedural success. Other authors have presented the same results (6, 7, 8, 9, 10).
As part of the ageing process, coronary arteries are prone to dilation, medial calcification, and impairment of endothelial function. These alterations have contributed to the lower success rates reported for the elderly undergoing primary PTCA. However, the rate of successful PTCA reported in our study is comparable to the that of younger patients. Our results are similar to other studies (8, 11, 12).
LIMITATIONS
Retrospective data is a significant limitation of the study, causing gaps in clinical data which cannot be filled at present. The investigated group of patients was only observed during short periods in hospital. In comparison with large randomised studies, our conclusions are only based on a small group of patients.
CONCLUSIONS
1. The elderly more often have multi-vessel coronary disease than younger patients. All the same, single-vessel disease was present in over 25% of elderly patients with AMI.
2. Primary PTCA in the elderly with AMI is safe and as effective in achieving reperfusion as in younger patients.
Piśmiennictwo
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