Document Detail


Comparison of epicardial and myocardial perfusions after primary coronary angioplasty for ST-elevation myocardial infarction in patients under and over 75 years of age.
MedLine Citation:
PMID:  20009495     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: Patients aged ≥75 years compose a high-risk subgroup for acute myocardial infarction (AMI). It is unknown whether myocardial perfusion in these patients is decreased compared with younger ones after primary percutaneous coronary intervention (PPCI), which may contribute to their worse prognosis. We compared epicardial and myocardial perfusions as well as short-term outcomes between elderly and younger patients undergoing PPCI.
METHODS: A total of 547 consecutive PPCI patients were prospectively enrolled; of these, 106 were elderly (≥75 yrs). Epicardial perfusion was evaluated by the Thrombolysis in Myocardial Infarction (TIMI) flow grade and corrected TIMI frame count (CTFC), and myocardial perfusion was evaluated by the TIMI myocardial perfusion grade (TMPG) and ST-segment resolution (STR).
RESULTS: Despite comparable epicardial perfusion pre- and post-PPCI, elderly patients had impaired myocardial perfusion after PPCI, as measured by reduced TMPG (35.9% vs 14.5%, p=0.001) and absent STR (18.9% vs 9.8%, p=0.009). After adjusting for clinical and angiographic risk profiles, multivariate analysis showed that age ≥75 years remained independently associated with reduced TMPG or absent STR. In the whole population, multivariate analysis revealed that both age ≥75 years and absent STR were independently associated with 3-month major adverse cardiac events (MACE). In the elderly subgroup, multivariate analysis identified absent STR as the strongest determinant of 3-month MACE.
CONCLUSIONS: Age is associated with impaired myocardial perfusion, but not epicardial perfusion, after PPCI for AMI. To further improve the outcome of elderly AMI patients, efforts should be aimed at improving myocardial perfusion beyond epicardial recanalization.
Authors:
Jun Pu; Song Ding; Peiren Shan; Zhiqin Qiao; Wei Song; Yongping Du; Jieyan Shen; Shuxuan Jin; Ben He
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-01
Journal Detail:
Title:  Aging clinical and experimental research     Volume:  22     ISSN:  1594-0667     ISO Abbreviation:  Aging Clin Exp Res     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-11-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101132995     Medline TA:  Aging Clin Exp Res     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  295-302     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Shanghai Renji Hospital, Shanghai Jiaotong University, Shanghai, 200127, China.
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