Systematic primary angioplasty in octogenarian and older patients

Background There are conflicting data about the efficacy of aggressive trea tment and early intervention among highrisk patients with acute myocardial infarction (AMI), such as elderly patients. This study sought to determine the short- and long-term outcome of octogenarian and older patients after p rimary percutaneous transluminal coronary angioplasty (PTCA). Methods In our tertiary referral center a program of primary PTCA was begun in 1995, and the systematic care for AMI included primary PTCA in all pati ents with AMI, with no age restriction. Over a period of 3 years, 55 octoge narian or older patients underwent primary PTCA. Results Between January 1995 and July 1998, 719 patients with AMI underwent primary PTCA. OF these, 55 patients were octogenarians or order (mean age, 84 +/- 3 years). Primary PTCA failure occurred in 3 (5%) patients. An opti mal acute angiographic result was achieved in 51 (93%) patients. Stenting o f the infarct vessel was accomplished in 33 (60%) patients. The 30-day mort ality rate was 16%. The mortality rate was 4% in patients without cardiogen ic shock on presentation and 70% in patients with cardiogenic shock. The re current ischemia rate was 13% and resulted in nonfatal reinfarction in 2 pa tients and repeat PTCA in 5 patients. As determined by multivariate analysi s, an optimal acute angiographic result and cardiogenic shock were signific antly related to mortality. The 1-year survival rate was 77%. Conclusions The results of this study suggest that the benefits of primary PTCA apply to the very elderly and support on early aggressive strategy for this high-risk patient subset.