Early clinical results of primary angioplasty and stenting in acute myocardial infarction in the elderly

Marzenna Zielinska, Krzysztof Kaczmarek, Jan Krekora, Wlodzimierz Koniarek

Summary
Acute myocardial infarction (AMI) is one of the main causes of death in advanced age. Primary angioplasty (PTCA) is the best method of treatment in young patients. Its effectiveness in elderly patients is unclear.
The aim of this study was to compare early results of invasive treatment of AMI with conservative therapy, in elderly patients.
Study group and methods: We analysed 175 pts (=75 years old) hospitalised due to AMI. Patients were divided according to their treatment into: group I (92 pts) subjected to primary PTCA, and group II (88 pts) treated conservatively. We compared the clinical characteristics and early clinical outcomes in both groups.
Results: The baseline characteristics of the groups were comparable. Only the incidence of hypertension and history of previous myocardial infarction differed between groups. The hospital outcome in group II was more frequently complicated by heart failure (29.55% vs. 15.21%, p<0.001) or by cardiogenic shock (31.82% vs. 11.96%). The hospital death rate was significantly higher in group II (37.5% vs. 17.4%), and was associated first of all with cardiogenic shock. Atrio-ventricular conduction disturbances (21.59% vs. 7.6%) and reinfarction (6.81% vs. 3.26%) were also more frequent in the conservatively treated pts.
Hospital stay was significantly shorter in group I (10.7 vs. 17.0 days).
Conclusions: 1. Primary PTCA in the elderly seems to be a safer method and more effective than conservative therapy. 2. Primary PTCA significantly decreases mortality in the elderly in comparison to conservative therapy. 3. Cardiogenic shock remains the most important risk factor in predicting the outcome of AMI in the elderly.

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