PROCEDURAL OUTCOMES OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ELDERLY PATIENTS WITH STEMI
AbstractBackground: Cardiovascular disease (CVD) is the leading cause of death worldwide, and coronary artery disease (CAD) is the most prevalent manifestation associated with high mortality and morbidity. Older age is independent predictor of cardiovascular mortality and death. Elderly may experience high rates of complications following acute STEMI. Optimal reperfusion strategy in elderly following STEMI remains under debate due to their exclusion from trials evaluating various treatment modalities. Primary PCI has emerged as treatment of choice in patients presenting with acute STEMI in a certain window period. The rationale of this study is to help us determine the outcome of primary PCI in the local elderly population. Methods: The study was designed as descriptive cross-sectional study and was carried out at AFIC, NIHD hospital Rawalpindi over a six months period. A total of 105 adults with STEMI were included in study. Data was analysed using SPSS 19.0 version. Results: Total 105 patients were included in the study according to the inclusion criteria of the study. There were 102 (97.1%) patients who successfully achieved TIMI II flow post Primary PCI. Conclusion: We concluded that outcome of primary pci in local elderly population is favourable which leads to a consensus that primary PCI should be offered to every elderly patient presenting to tertiary care hospital with well-equipped Cath lab and experienced staff.Keywords: Primary PCI; elderly; myocardial infarction
Tsounis D, Deftereos S, Bouras G, Giannopoulos G, Anatoliotakis N, Raisakis K, et al. High sensitivity troponin in cardiovascular disease. Is there more than a marker of myocardial death? Curr Top Med Chem 2013;13(2):201–15.
Miura T, Soga Y, Doijiri T, Aihara H, Yokoi H, Iwabuchi M, et al. Prevalence and clinical outcome of polyvascular atherosclerotic disease in patients undergoing coronary intervention. Circ J 2013;77(1):89–95.
Renilla A, Barreiro M, Barriales V, Torres F, Alvarez P, Lambert JL. Management and risk factors for mortality in very elderly patients with acute myocardial infarction. Geriatr Gerontol Int 2013;13(1):146–51.
Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW, et al. Acute coronary care in theelderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007;115(19):2570–89.
Bauer T, Möllmann H, Weidinger F, Zeymer U, Seabra-Gomes R, Eberli F, et al. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int J Cardiol 2011;151(2):164–9.
Covino M, Simeoni B, Montalto M, Burzotta F, Buccelletti F, Carbone L, et al. Reduced performance of Troponin T for acute coronary syndromes diagnosis in the elderly and very elderly patients: a retrospective study of 2688 patients. Eur Rev Med Pharmacol Sci 2012;16(Suppl 1):8–15.
Kizer JR, Benkeser D, Arnold AM, Djousse L, Zieman SJ, Mukamal KJ, et al. Total and high-molecular-weight adiponectin and risk of coronary heart disease and ischemic stroke in older adults. J Clin Endocrinol Metab 2013;98(1):255–63.
Leveille SG. Musculoskeletal aging. Curr Opin Rheumatol 2004;16(2):114–8.
Thomas LA. Effective dyspnea management strategies identified by elders with end-stage chronic obstructive pulmonary disease. Appl Nurs Res 2009;22(2):79–85.
Parikh R, Chennareddy S, Debari V, Hamdan A, Konlian D, Shamoon F, et al. Percutaneous coronary interventions in nonagenarians: in-hospital mortality and outcome at one-year follow-up. Clin Cardiol 2009;32(12):E16–21.
Armstrong PW, WEST Steering Committee. A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study. Eur Heart J 2006;27(13):1530–8.
Velders MA, James SK, Libungan B, Sarno G, Fröbert O, Carlsson J, et al. Prognosis of elderly patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001–2011: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry. Am Heart J 2014;167(5):666–73.
Roe MT, Messenger JC, Weintraub WS, Cannon CP, Fonarow GC, Dai D, et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol 2010;56(4):254–63.
Graham MM, Ghali WA, Faris PD, Galbraith PD, Norris CM, Knudtson ML. Survival after coronary revascularization in the elderly. Circulation 2002;105(20):2378–84.
Moonen LA, van’t Veer M, Pijls NH. Procedural and long-term outcome of primary percutaneous coronary intervention in octogenarians. Neth Heart J 2010;18(3):129–34.
Shanmugasundaram MD. Percutaneous coronary intervention in elderly patients: Is It Beneficial? Tex Heart Inst J 2011;38(4):398–403.
Gao L, Hu X, Liu YQ, Xue Q, Feng QZ. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction. Clin Interv Aging 2014;9:1241–6.
Alkhushail A, Kohli S, Mitchel A, Smith R, Ilsely C. Prognosis of primary percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction. J Saudi Heart Assoc 2015;27(2):85–90.
Conrotto F, Scacciatella P, D'Ascenzo F, Chieffo A, Latib A, Park SJ, et al. Long-term outcomes of percutaneous coronary interventions or coronary artery bypass grafting for left main coronary artery disease in octogenarians (from a drug-eluting stent for left main artery registry sub-study). Am J Cardiol 2014;113(12):2007–12.
Vavalle JP, Rao SV. Impact of bleeding complications on outcomes after percutaneous coronary intervention. Interv Cardiol 2009;1(1):51–62.
Chhatriwalla AK, Amin AP, Kennedy KF, House JA, Cohen DJ, Rao SV, et al. Association between bleeding events and in-hospital mortality after percutaneous coronary intervention. JAMA 2013;309(10):1022–9.