| Primary coronary angioplasty vs thrombolysis for the management of acute myocardial infarction in elderly patients. | |
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MedLine Citation:
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PMID: 10432031 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: Despite evidence from randomized trials that, compared with early thrombolysis, primary percutaneous transluminal coronary angioplasty (PTCA) after acute myocardial infarction (AMI) reduces mortality in middle-aged adults, whether elderly patients with AMI are more likely to benefit from PTCA or early thrombolysis is not known. OBJECTIVE: To determine survival after primary PTCA vs thrombolysis in elderly patients. DESIGN: The Cooperative Cardiovascular Project, a retrospective cohort study using data from medical charts and administrative files. SETTING: Acute care hospitals in the United States. PATIENTS: A total of 20683 Medicare beneficiaries, who arrived within 12 hours of the onset of symptoms, were admitted between January 1994 and February 1996 with a principal discharge diagnosis of AMI, and were eligible for reperfusion therapy. MAIN OUTCOME MEASURES: Thirty-day and 1-year survival. RESULTS: A total of 80356 eligible patients had an AMI at hospital arrival and met the inclusion criteria, of whom 23.2% received thrombolysis and 2.5% underwent primary PTCA within 6 hours of hospital arrival. Patients undergoing primary PTCA had lower 30-day (8.7% vs 11.9%, P=.001) and 1-year mortality (14.4% vs 17.6%, P=.001). After adjusting for baseline cardiac risk factors and admission and hospital characteristics, primary PTCA was associated with improved 30-day (hazard ratio [HR] of death, 0.74; 95% confidence interval [CI], 0.63-0.88) and 1-year (HR, 0.88; 95% CI, 0.73-0.94) survival. The benefits of primary coronary angioplasty persisted when stratified by hospitals' AMI volume and the presence of on-site angiography. In patients classified as ideal for reperfusion therapy, the mortality benefit of primary PTCA was not significant at 1-year follow-up (HR, 0.92; 95% CI, 0.78-1.08). CONCLUSION: In elderly patients who present with AMI, primary PTCA is associated with modestly lower short- and long-term mortality rates. In the subgroup of patients who were classified as ideal for reperfusion therapy, the observed benefit of primary PTCA was no longer significant. |
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Authors:
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A K Berger; K A Schulman; B J Gersh; S Pirzada; J A Breall; A E Johnson; N R Every |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 282 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 1999 Jul |
Date Detail:
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Created Date: 1999-08-05 Completed Date: 1999-08-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 341-8 Citation Subset: AIM; IM |
Affiliation:
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Institute for Cardiovascular Sciences, Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* Cohort Studies Female Humans Male Morbidity Myocardial Infarction / drug therapy, therapy* Proportional Hazards Models Retrospective Studies Risk Survival Analysis Thrombolytic Therapy* Treatment Outcome |
| Comments/Corrections | |
Comment In:
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JAMA. 2000 Feb 2;283(5):601-2
[PMID:
10665691
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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