Abstract
BackgroundAbout eighty percent of acute myocardial infarction (AMI) cases occur in the elderly, we aim to examine the use of reperfusion strategies in elderly patients (≥65 years) with AMI and to investigate the factors affecting the use of these strategies.MethodsA total of 352 consecutive elderly patients (≥65 years) with ST-elevated AMI (STAMI) were admitted, they were divided into 2 groups based on reperfusion treatment (thrombolysis or percutaneous coronary intervention, PCI): reperfusion therapy group (n = 268) and non-reperfusion therapy group (n = 84). Demographic and medical data were collected for comparison. Odds ratios (OR) and 95% confidence interval (C.I.) were calculated directly from the estimated regression coefficients.ResultsAbout 76.1% of the elderly patients with AMI received reperfusion treatment (62.5% received PCI, and 13.6% received thrombolysis). Stepwise Logistic regression analysis revealed that a patient age ≥75 years (95% CI: 0.194 ~ 0.590, OR = 0.338, P = 0.000) and medical history of angina (95% CI: 0.281 ~ 0.928, OR = 0.501, P = 0.014) were determining factors for receiving less reperfusion therapy. Complications including right ventricular myocardial infarction (MI) (95% CI: 1.618 ~ 12.907, OR = 4.472, P = 0.003), unbearable symptoms (95% CI: 1.132 ~ 3.928, OR = 1.839, P = 0.021) and medical insurance (95% CI: 1.313 ~ 4.524, OR = 2.429, P = 0.004) were independent predictors of reperfusion therapy. The reperfusion therapy subset analysis revealed that intracranial hemorrhage (2.7% vs. 8.3%, P = 0.000), left ventricular ejection fraction (LVEF) <45% (13.2% vs. 29.2%, P = 0.019) and mortality rate within 1 year (2.7% vs. 6.3%, P = 0.045) were significantly decreased in the PCI group as compared with thrombolysis.ConclusionElderly patients with a medical history of angina, right ventricular MI, unbearable symptoms and medical insurance are likely be recipients of reperfusion strategies.
Highlights
About eighty percent of acute myocardial infarction (AMI) cases occur in the elderly, we aim to examine the use of reperfusion strategies in elderly patients (≥65 years) with AMI and to investigate the factors affecting the use of these strategies
The prospective survey-included patients consisted of 352 consecutive cases of elderly patients with ST-elevated myocardial infarction (STEMI) (≥65 years) who were admitted to the coronary care unit of the Beijing military general hospital from February 2005 to February 2009
The exclusion criteria were (1) AMI occurred after admission for other diseases; (2) the clinical state of the patient did not allow for inclusion, as decided by a physician; and (3) the patient did not agree to participate in the study
Summary
About eighty percent of acute myocardial infarction (AMI) cases occur in the elderly, we aim to examine the use of reperfusion strategies in elderly patients (≥65 years) with AMI and to investigate the factors affecting the use of these strategies. Acute myocardial infarction (AMI) or ‘heart attack’ is one of the top ten leading causes of death worldwide [1], about eighty percent of AMI cases occur in the elderly [2]. A clinically relevant research for coronary heart disease in elderly patients is needed, especially for those with ST-elevated myocardial infarction (STEMI). STEMI, resulted from a rupture of coronary artery plaque followed by a thrombosis, could cause acute coronary artery blockages and flow interruption. Effective and continued opening of the infarct related artery (IRA) is crucial to protecting left ventricular function
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