Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly |
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Authors: | Bimmer EPM Claessen Wouter J Kikkert Loes P Hoebers Hassina Bahadurzada Marije M Vis Jan Baan Karel T Koch Robbert J de Winter Jan GP Tijssen Jan J Piek José PS Henriques |
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Institution: | Department of Cardiology, B2-115, Academic Medical Center – University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, AZ The Netherlands |
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Abstract: | BackgroundThe population is ageing rapidly and the proportion of patients aged ≥ 80 years undergoing primary percutaneous coronary intervention (PCI) is rising, but clinical trials have primarily been performed in younger patients.MethodsPatients undergoing primary PCI between 2003 and 2008 were subdivided into 3 groups: < 60, 60-79, and ≥ 80 years. Endpoints at 3-year follow-up included all-cause mortality, recurrent myocardial infarction (reMI), stent thrombosis, target lesion revascularisation (TLR), bleeding (BARC bleeding ≥ 3), stroke, and major adverse cardiovascular events (MACE, a composite of cardiac mortality, reMI, stroke and TLR).Results2002 patients with ST-segment elevation myocardial infarction (STEMI) were included, 885 (44.2 %) aged < 60, 921 (46.0 %) 60–79, and 196 (9.7 %) ≥ 80 years. Comorbidities such as diabetes mellitus, prior stroke, malignant disease, anaemia, and chronic kidney disease were more prevalent in patients ≥ 80 years. The incidence of both ischaemic and bleeding events strongly increased with age. Age ≥ 80 years was an independent predictor of mortality (HR 2.56, 95 % CI1.69–3.87, p < 0.001), a borderline non-significant predictor of overall bleeding (HR 1.38, 95 %CI 0.95–2.00, p = 0.088), and a significant predictor of non-access site bleeding (HR 2.26, 95 %CI 1.46–3.51, p < 0.001).ConclusionPatients ≥ 80 years experienced high rates of ischaemic and bleeding complications; especially in this high-risk patient group individualised therapy is needed to optimise clinical outcomes.Electronic Supplementary MaterialThe online version of this article (doi:10.1007/s12471-015-0733-2 contains supplementary material, which is available to authorized users. |
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Keywords: | Primary percutaneous coronary intervention Acute myocardial infarction Stent Elderly |
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