Percutaneous coronary intervention in elderly patients: clinical benefits and challenges from single center experience.

Abstract

Objectives: Elderly patients who present with acute myocardial infarction are at increased risk for adverse outcomes owing to higher comorbidity burden and complicated coronary anatomy. We evaluated the three-year outcomes following coronary revascularization compared to conservative management among elderly patients presenting with acute myocardial infarction.

Methods: 155 patients over 75 years of age who were admitted for acute myocardial infarction underwent invasive treatment with coronary angioplasty (n=58) or only medical treatment (n=97). The Kaplan-Meier log rank test was used to compare 3-year survival and rehospitalization probability and the Mantel-Cox log rank test was used to compare mean survival time between groups.

Results: In the Invasive treatment group (ITG) cohort, 3-year survival probability was 74.1% as compared to 29.9% in the Conservative treatment group (CTG) cohort (P<0.001). Mean survival time at 3 years of follow-up was 31.50 (95% CI 29.35-33.65) months among ITG patients versus 24.65 (95% CI 22.71-26.59) months among CTG patients (P<0.001). Mean time to rehospitalization at 3 years was 34.05 (95% CI 32.37-35.72) in the ITG cohort compared to 30.03 (95% CI 28.13-31.93) in the CTG cohort (P=0.004).

Conclusion: Coronary revascularization among elderly patients with acute myocardial infarction reduces both all-cause mortality and cardiovascular events at 3-year follow-up. However, rates of rehospitalizations remain statistically similar between groups. Moreover, invasive treatment imparted improved rehospitalization probability compared to conservative treatment. This observation can be partially explained by a reduction in the frequency of myocardial infarction among those who underwent invasive treatment. While a thorough clinical assessment is required prior to treatment determination among elderly patients with acute myocardial infarction, coronary revascularization should be strongly considered as an intervention that likely improves overall survival probability.