Clinical investigations: interventional cardiologyImpact of ST-segment resolution after primary angioplasty on outcomes after myocardial infarction in elderly patients: an analysis from the CADILLAC trial☆
Section snippets
Methods
The details of the CADILLAC trial protocol have been published previously.18 In brief, 2082 patients were enrolled in 76 centers in 9 countries between November 1997 and September 1999. The inclusion criteria were age >18 years (with no upper limit), presence of at least 30 minutes but <12 hours of symptoms consistent with AMI, and presence of ST-segment elevation in at least 2 contiguous leads or new left bundle-branch block. Patients with other electrocardiographic patterns were enrolled when
Results
A total of 695 patients with AMI and serial interpretable ST-segment analyses within the appropriate time frame were included in the STR substudy. The clinical characteristics of the study population stratified by age are summarized in Table I. Patients in the older age groups were more likely to be women, had a higher prevalence of hypertension and diabetes mellitus, and were less likely to be current smokers. Increasing age was also associated with a greater likelihood of congestive heart
Discussion
This study suggests that increasing age is not associated with lower rates of STR after primary PCI for AMI. Thus, adverse outcomes in elderly patients are unrelated to the primary PCI procedure itself, and lack of myocardial reperfusion is not the predominant mechanism responsible for the increasing morbidity and mortality rates. This thus strengthens the argument that advanced age is not a contraindication for primary PCI and may be the preferred management approach to AMI. In addition,
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2021, Heart Lung and CirculationCitation Excerpt :In some studies, elderly patients with AMI were found to be more underweight and of normal weight. Several reports have shown that elderly patients with AMI had adverse clinical outcomes despite aggressive treatment [27]. The current study, which revealed that underweight elderly patients with AMI had more adverse clinical outcomes, showed that excess nutrients can have positive effects on injured myocardium instantly after AMI.
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2018, Endothelium and Cardiovascular Diseases: Vascular Biology and Clinical SyndromesLong-term clinical outcome of elderly patients with acute coronary syndrome treated with early percutaneous coronary intervention: Insights from the BASE ACS randomized controlled trial: Bioactive versus everolimus-eluting stents in elderly patients
2017, European Journal of Internal MedicineCitation Excerpt :In an early pooled analysis of the PAMI trials (bare-metal stents), patients above 75 years had higher cardiac and non-cardiac in-hospital mortality; age ≥ 75 years was an independent predictor of in-hospital mortality, along with lower left ventricular ejection fraction, lower final TIMI flow, higher Killip class, need for an intra-aortic balloon counterpulsation, and post-MI stroke/transient ischemic attack, or significant arrhythmia, [21]. In post hoc analysis of the CADILLAC trial in patients with acute MI undergoing primary PCI, 1-year mortality increased exponentially after the age of 65 years, independent of the reperfusion modality or the use of abciximab; both age and absent ST-segment resolution were independent predictors of 30-day MACE [22,23]. Yet, in patients with ST-segment elevation MI treated by primary PCI, increasing age was associated with poor myocardial perfusion (as reflected by myocardial blush grade 0–1 and ST-segment resolution < 50%); both age and poor myocardial perfusion were independent predictors of 1-year mortality [24].
Association between clinical parameters and ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction
2016, Medicina (Lithuania)Citation Excerpt :In our study we found that patients’ age, infarct duration, localization and epicardial blood flow after PPCI were important associates of myocardium damage reflected by STR. Previous studies of STR after PPCI for patients with STEMI did not find statistically significant association between patients’ age and STR [4,11,12]. Yet, one of the associates of incomplete STR in our study was higher patients’ age.
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Guest Editor for this manuscript was Frank Aquirre, MD, Prairie Cardiovascular Consultants, Ltd, Springfield, Ill.