AGE – RELATED TREATMENT STRATEGY AND LONG-TERM OUTCOME IN ACUTE MYOCARDIAL INFARCTION PATIENTS IN THE PCI ERA

Aims: To analyze age-related differences in treatment strategies, results of PCI procedures and both in-hospital and long-term outcomes of consecutive patients suffering from acute myocardial infarction.
Methods: Retrospective multicenter analysis of 3814 consecutive acute myocardial infarction patients divided into two groups (younger population, elderly population) according to age (1800 patients ≤ 65 years and 2014 patients > 65 years).
Results: The elderly population had a significantly lower rate of coronary angiography (1726; 95.9% vs. 1860; 92.4%, p < 0.0001), PCI (1541; 85.6% vs. 1505; 74.7%, p < 0.001), achievement of optimal final TIMI flow 3 (1434; 79.7% vs. 1343; 66.7%, p < 0.001) and higher rate of unsuccessful reperfusion with final TIMI flow 0-1 (46; 2.6% vs. 78; 3.9%, p = 0.022). A total of 217 patients (5.7%) died during hospitalization, with significantly higher percentages in the elderly population (46; 2.6% vs. 171; 8.5%, p < 0.001). The long-term mortality (calculated from data for 2847 patients from 2 centers) was higher in the elderly population as well (5 years survival: 86.1% vs. 59.8%). We clearly demonstrated age as a strong discriminator for the whole population of AMI patients. Severe heart failure on admission (Killip III-IV) was associated with the worst prognosis in both groups of patients, but was less pronounced as a risk factor in the elderly (HR 6.04 vs. 3.14, p = 0.051 for Killip III and 12.24 vs. 5.65, p = 0.030 for Killip IV).
Conclusions: In the studied AMI population, older age was associated with a less pronounced impact of risk factors on long-term outcome. PCI in the elderly is at least as important as in younger patients, but its primary success rate is lower. Age was a dominant discriminating factor in all patients.