Effect of age on the outcome of angioplasty for acute myocardial infarction among patients treated at the Mayo Clinic
PURPOSE: Elderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in patients with acute myocardial infarction. We compared the outcomes of elderly patients who underwent coronary angioplasty with the outcomes...
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Published in | The American journal of medicine Vol. 108; no. 3; pp. 187 - 192 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Elsevier Inc
15.02.2000
Elsevier Elsevier Sequoia S.A |
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Abstract | PURPOSE: Elderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in patients with acute myocardial infarction. We compared the outcomes of elderly patients who underwent coronary angioplasty with the outcomes of younger patients and determined whether there were any temporal trends in survival.
PATIENTS AND METHODS: We reviewed the outcomes of 1,597 consecutive patients who underwent primary coronary angioplasty between 1979 and 1997, including 127 patients who were 80 years of age or older (mean [±SD] age, 83 ± 3 years, 47% male). Their in-hospital and long-term outcomes were compared with those of 524 patients who were 70 to 79 years old, 527 patients who were 60 to 69 years old, and 419 patients who were 50 to 59 years old. The oldest group of patients was divided into two groups, based on whether they had intervention through the end of 1993 (n = 56) or between 1994 and 1997 (n = 71). The survival rate of the patients who had no complications and left the hospital was compared with expected survival based on age- and sex-adjusted data.
RESULTS: Patients 80 years of age or older had more adverse baseline characteristics, including risk factors and comorbid conditions, than the younger patients. The clinical success rate of primary angioplasty in this group was lower than those in the other three groups (61% versus 74% in those aged 70 to 79 years, 73% in those aged 60 to 69 years, and 81% in those aged 50 to 59 years,
P < 0.001). The in-hospital mortality rate among patients 80 years of age or older was significantly greater than among patients in the other three groups (21% in those aged 80 years or older, 13% in those aged 70 to 79 years, 9% in those aged 60 to 69 years, and 4% in those aged 50 to 59 years,
P < 0.001). The clinical success rate of the angioplasty improved significantly in the more recent period (75% versus 45%,
P = 0.0006) and in-hospital mortality declined (16% versus 29%,
P = 0.07). During follow-up, mortality in the oldest age group in whom angioplasty was successful was significantly greater than in the three younger groups, but was similar to the expected survival in the general US population.
CONCLUSIONS: The mortality associated with primary angioplasty for acute myocardial infarction in octogenarians remains high, although there has been significant improvement in the clinical success rate. The long-term prognosis following a successful angioplasty is not different from that in an age- and sex-adjusted U.S. white population. |
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AbstractList | PURPOSEElderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in patients with acute myocardial infarction. We compared the outcomes of elderly patients who underwent coronary angioplasty with the outcomes of younger patients and determined whether there were any temporal trends in survival.PATIENTS AND METHODSWe reviewed the outcomes of 1,597 consecutive patients who underwent primary coronary angioplasty between 1979 and 1997, including 127 patients who were 80 years of age or older (mean [+/-SD] age, 83 +/- 3 years, 47% male). Their in-hospital and long-term outcomes were compared with those of 524 patients who were 70 to 79 years old, 527 patients who were 60 to 69 years old, and 419 patients who were 50 to 59 years old. The oldest group of patients was divided into two groups, based on whether they had intervention through the end of 1993 (n = 56) or between 1994 and 1997 (n = 71). The survival rate of the patients who had no complications and left the hospital was compared with expected survival based on age- and sex-adjusted data.RESULTSPatients 80 years of age or older had more adverse baseline characteristics, including risk factors and comorbid conditions, than the younger patients. The clinical success rate of primary angioplasty in this group was lower than those in the other three groups (61% versus 74% in those aged 70 to 79 years, 73% in those aged 60 to 69 years, and 81% in those aged 50 to 59 years, P < 0.001). The in-hospital mortality rate among patients 80 years of age or older was significantly greater than among patients in the other three groups (21% in those aged 80 years or older, 13% in those aged 70 to 79 years, 9% in those aged 60 to 69 years, and 4% in those aged 50 to 59 years, P < 0.001 ). The clinical success rate of the angioplasty improved significantly in the more recent period (75% versus 45%, P = 0.0006) and in-hospital mortality declined (16% versus 29%, P = 0.07). During follow-up, mortality in the oldest age group in whom angioplasty was successful was significantly greater than in the three younger groups, but was similar to the expected survival in the general US population.CONCLUSIONSThe mortality associated with primary angioplasty for acute myocardial infarction in octogenarians remains high, although there has been significant improvement in the clinical success rate. The long-term prognosis following a successful angioplasty is not different from that in an age- and sex-adjusted U.S. white population. Elderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in patients with acute myocardial infarction. We compared the outcomes of elderly patients who underwent coronary angioplasty with the outcomes of younger patients and determined whether there were any temporal trends in survival. We reviewed the outcomes of 1,597 consecutive patients who underwent primary coronary angioplasty between 1979 and 1997, including 127 patients who were 80 years of age or older (mean [+/-SD] age, 83 +/- 3 years, 47% male). Their in-hospital and long-term outcomes were compared with those of 524 patients who were 70 to 79 years old, 527 patients who were 60 to 69 years old, and 419 patients who were 50 to 59 years old. The oldest group of patients was divided into two groups, based on whether they had intervention through the end of 1993 (n = 56) or between 1994 and 1997 (n = 71). The survival rate of the patients who had no complications and left the hospital was compared with expected survival based on age- and sex-adjusted data. Patients 80 years of age or older had more adverse baseline characteristics, including risk factors and comorbid conditions, than the younger patients. The clinical success rate of primary angioplasty in this group was lower than those in the other three groups (61% versus 74% in those aged 70 to 79 years, 73% in those aged 60 to 69 years, and 81% in those aged 50 to 59 years, P < 0.001). The in-hospital mortality rate among patients 80 years of age or older was significantly greater than among patients in the other three groups (21% in those aged 80 years or older, 13% in those aged 70 to 79 years, 9% in those aged 60 to 69 years, and 4% in those aged 50 to 59 years, P < 0.001 ). The clinical success rate of the angioplasty improved significantly in the more recent period (75% versus 45%, P = 0.0006) and in-hospital mortality declined (16% versus 29%, P = 0.07). During follow-up, mortality in the oldest age group in whom angioplasty was successful was significantly greater than in the three younger groups, but was similar to the expected survival in the general US population. The mortality associated with primary angioplasty for acute myocardial infarction in octogenarians remains high, although there has been significant improvement in the clinical success rate. The long-term prognosis following a successful angioplasty is not different from that in an age- and sex-adjusted U.S. white population. PURPOSE: Elderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in patients with acute myocardial infarction. We compared the outcomes of elderly patients who underwent coronary angioplasty with the outcomes of younger patients and determined whether there were any temporal trends in survival. PATIENTS AND METHODS: We reviewed the outcomes of 1,597 consecutive patients who underwent primary coronary angioplasty between 1979 and 1997, including 127 patients who were 80 years of age or older (mean [±SD] age, 83 ± 3 years, 47% male). Their in-hospital and long-term outcomes were compared with those of 524 patients who were 70 to 79 years old, 527 patients who were 60 to 69 years old, and 419 patients who were 50 to 59 years old. The oldest group of patients was divided into two groups, based on whether they had intervention through the end of 1993 (n = 56) or between 1994 and 1997 (n = 71). The survival rate of the patients who had no complications and left the hospital was compared with expected survival based on age- and sex-adjusted data. RESULTS: Patients 80 years of age or older had more adverse baseline characteristics, including risk factors and comorbid conditions, than the younger patients. The clinical success rate of primary angioplasty in this group was lower than those in the other three groups (61% versus 74% in those aged 70 to 79 years, 73% in those aged 60 to 69 years, and 81% in those aged 50 to 59 years, P < 0.001). The in-hospital mortality rate among patients 80 years of age or older was significantly greater than among patients in the other three groups (21% in those aged 80 years or older, 13% in those aged 70 to 79 years, 9% in those aged 60 to 69 years, and 4% in those aged 50 to 59 years, P < 0.001). The clinical success rate of the angioplasty improved significantly in the more recent period (75% versus 45%, P = 0.0006) and in-hospital mortality declined (16% versus 29%, P = 0.07). During follow-up, mortality in the oldest age group in whom angioplasty was successful was significantly greater than in the three younger groups, but was similar to the expected survival in the general US population. CONCLUSIONS: The mortality associated with primary angioplasty for acute myocardial infarction in octogenarians remains high, although there has been significant improvement in the clinical success rate. The long-term prognosis following a successful angioplasty is not different from that in an age- and sex-adjusted U.S. white population. The mortality associated with primary angioplasty for acute myocardial infarction in octogenarians remains high, although there has been significant improvement in the clinical success rate. |
Author | Grill, Diane E Rihal, Charanjit S Holmes, David R Singh, Mandeep Garratt, Kirk N Bell, Malcolm R Mathew, Verghese Berger, Peter B |
Author_xml | – sequence: 1 givenname: Mandeep surname: Singh fullname: Singh, Mandeep organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 2 givenname: Verghese surname: Mathew fullname: Mathew, Verghese organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 3 givenname: Kirk N surname: Garratt fullname: Garratt, Kirk N organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 4 givenname: Peter B surname: Berger fullname: Berger, Peter B organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 5 givenname: Diane E surname: Grill fullname: Grill, Diane E organization: Section of Biostatistics (DEG), Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 6 givenname: Malcolm R surname: Bell fullname: Bell, Malcolm R organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 7 givenname: Charanjit S surname: Rihal fullname: Rihal, Charanjit S organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA – sequence: 8 givenname: David R surname: Holmes fullname: Holmes, David R organization: Division of Cardiovascular Diseases and Internal Medicine (MS, VM, KNG, PBB, MRB, CSR, DRH) , Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA |
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Keywords | Human Evaluation Prognosis Infarct Angioplasty Acute Age criterion Cardiovascular disease Coronary heart disease Myocardial disease Long term Plasty Efficiency Surgery Myocardium Elderly Public health Comparative study |
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Snippet | PURPOSE: Elderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in... Elderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in patients... The mortality associated with primary angioplasty for acute myocardial infarction in octogenarians remains high, although there has been significant... PURPOSEElderly patients, especially those 80 years of age and older, have been excluded from most studies of thrombolysis or primary coronary angioplasty in... |
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SubjectTerms | Age Factors Aged Aged, 80 and over Angioplasty, Balloon, Coronary - adverse effects Biological and medical sciences Cardiology. Vascular system Chi-Square Distribution Female Heart Heart attacks Humans Male Medical sciences Middle Aged Mortality Myocardial Infarction - therapy Myocarditis. Cardiomyopathies Older people Survival Analysis Treatment Outcome |
Title | Effect of age on the outcome of angioplasty for acute myocardial infarction among patients treated at the Mayo Clinic |
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