Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience

Abstract

Elderly patients are under-represented in trials assessing strategies of early coronary revascularization in acute myocardial infarction, though they are the fastest growing segment of our population. The aims of the present investigation, performed in 357 elderly (≥75 years) patients with ST elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) consecutively admitted to our Intensive Cardiac Care Unit (ICCU) from 1 January 2006 to 31 December 2009, were as follows: (a) to identify predictors for in-ICCU mortality among clinical, angiographic and metabolic factors and (b) to evaluate whether there are gender-related differences in management, outcome and in the metabolic and inflammatory responses to acute myocardial ischemia. At multivariable backward stepwise logistic regression analysis, the following variables were independent predictors for in-ICCU mortality in the overall population: age (OR 1.15; 95% CI 1.05-1.27; p < 0.003), admission glycemia (OR 2.24; 95% CI 1.41-3.56; p < 0.001), left ventricular ejection fraction (LVEF) (OR 0.92; 95% CI 0.88-0.97; p < 0.001), primary PCI failure (OR 4.70; 95% CI 1.70-12.98; p < 0.003). In elderly STEMI patients submitted to primary PCI, early mortality can be related to age, hemodynamic derangement (as indicated by LVEF), the rate of procedural success, and increased glucose values. No gender-related differences in management were detectable in our series. Our data strongly suggest that, in elderly patients in the acute phase of STEMI, since hyperglycemia is a modifying factor, glucose values deserve a more intensive treatment. Further studies, performed specifically in elderly STEMI patients, should be addressed to identify the glucose cut-off values able to influence the outcome.