1. Multivessel disease in patients over 75years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI+75 nation-wide registry.
- Author
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de La Torre Hernandez JM, Gomez Hospital JA, Baz JA, Brugaletta S, Perez de Prado A, Linares JA, Lopez Palop R, Cid B, Garcia Camarero T, Diego A, Gutierrez H, Fernandez Diaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas JM, Elizaga J, Arrebola AL, Hernandez F, Salvatella N, Monteagudo M, Gomez Jaume A, Carrillo X, Martin Reyes R, Lozano F, Rumoroso JR, Andraka L, and Dominguez AJ
- Subjects
- Age Factors, Aged, Aged, 80 and over, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Drug-Eluting Stents, Female, Humans, Male, Platelet Aggregation Inhibitors therapeutic use, Progression-Free Survival, Registries, Retrospective Studies, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction mortality, Spain, Time Factors, Coronary Artery Disease surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention mortality, ST Elevation Myocardial Infarction surgery
- Abstract
Background: In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known., Methods: Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes., Results: Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results., Conclusions: In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence., Summary: We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures., (Copyright © 2017. Published by Elsevier Inc.)
- Published
- 2018
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