Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM+75 Registry

• Published in: Revista española de cardiología (English ed.) Vol. 70; no. 2; pp. 81 - 87
• Main Authors: de la Torre Hernández, José M, Brugaletta, Salvatore, Gómez Hospital, Joan A, Baz, José A, Pérez de Prado, Armando, López Palop, Ramón, Cid, Belén, García Camarero, Tamara, Diego, Alejandro, Gimeno de Carlos, Federico, Fernández Díaz, José A, Sanchis, Juan, Alfonso, Fernando, Blanco, Roberto, Botas, Javier, Navarro Cuartero, Javier, Moreu, José, Bosa, Francisco, Vegas Valle, José M, Elízaga, Jaime, Arrebola, Antonio L, Ruiz Arroyo, José R, Hernández-Hernández, Felipe, Salvatella, Neus, Monteagudo, Marta, Gómez Jaume, Alfredo, Carrillo, Xavier, Martín Reyes, Roberto, Lozano, Fernando, Rumoroso, José R, Andraka, Leire, Domínguez, Antonio J
• Format: Journal Article
• Language: English
• Published: Spain 01-02-2017
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary - methods; Cause of Death - trends; Comorbidity; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Prognosis; Recurrence; Registries; Renal Insufficiency - epidemiology; Retrospective Studies; Spain - epidemiology; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - epidemiology; ST Elevation Myocardial Infarction - surgery; Survival Rate - trends; Time Factors; Myocardial infarction; Anciano; Infarto de miocardio; Angioplastia primaria; Elderly; Primary angioplasty
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2016.06.012

The proportion of elderly patients undergoing primary angioplasty is growing. The present study describes the clinical profile, procedural characteristics, outcomes, and predictors of outcome.
A 31-center registry of consecutive patients older than 75 years treated with primary angioplasty. Clinical and procedural data were collected, and the patients underwent clinical follow-up.
The study included 3576 patients (39.3% women, 48.5% with renal failure, 11.5% in Killip III or IV, and 29.8% with>6hours of chest pain). Multivessel disease was present in 55.4% and nonculprit lesions were additionally treated in 24.8%. Radial access was used in 56.4%, bivalirudin in 11.8%, thromboaspiration in 55.9%, and drug-eluting stents in 26.6%. The 1-month and 2-year incidences of cardiovascular death were 10.1% and 14.7%, respectively. The 2-year rates of definite or probable thrombosis, repeat revascularization, and BARC bleeding>2 were 3.1%, 2.3%, and 4.2%, respectively. Predictive factors were diabetes mellitus, renal failure, atrial fibrillation, delay to reperfusion>6hours, ejection fraction<45%, Killip class III-IV, radial access, bivalirudin, drug-eluting stents, final TIMI flow of III, and incomplete revascularization at discharge.
Notable registry findings include frequently delayed presentation and a high prevalence of adverse factors such as renal failure and multivessel disease. Positive procedure-related predictors include shorter delay, use of radial access, bivalirudin, drug-eluting stents, and complete revascularization before discharge.