Incremental Age-related One-year MACCE After Acute Myocardial Infarction in the Drug-eluting Stent Era (from KAMIR-NIH Registry)

Overview

Journal J Geriatr Cardiol

Specialty Geriatrics

Date 2018 Oct 23

PMID 30344541

Citations 4

Authors

Dae-Won Kim

Sung-Ho Her

Ha Wook Park

Kiyuk Chang

Wook Sung Chung

Ki Bae Seung

Myung Ho Jeong

Hyo-Soo Kim

Hyeon Cheol Gwon

In Whan Seong

Kyung Kuk Hwang

Shung Chull Chae

Kwon-Bae Kim

Young Jo Kim

Kwang Soo Cha

Seok Kyu Oh

Jei Keon Chae

Ji-Hoon Jung

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the age-related one-year major adverse cardiocerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). We analyzed the association between age and one-year MACCE after AMI.

Methods: A total of 13,104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institue of Health (KAMIR-NIH) between November 2011 and December 2015 were classified into four groups according to age (Group I, < 60 years, = 4199; Group II, 60-70 years, = 2577; Group III; 70-80 years, = 2774; Group IV, ≥ 80 years, = 1018). Patients were analyzed for one-year composite of MACCE (cardiac death, myocardial infarction, target vessel revascularization, cerebrovascular events) after AMI.

Results: The one-year MACCE in AMI were 3.5% (Group I), 6.3% (Group II), 9.6% (Group III) and 17.6% (Group IV). After adjustment for confounding parameters, the analysis results showed that patients with AMI had incremental risk of one-year MACCE [Group II, adjusted hazard ratios (aHR) = 1.224, 95% CI: 0.965-1.525, = 0.096; Group III, aHR = 1.316, 95% CI: 1.037-1.671, = 0.024; Group IV, aHR = 1.975, 95% CI: 1.500-62.601, < 0.001) compared to Group I. Especially, cardiac death in the composite of primary end point played a major role in this effect (Group II, aHR = 1.335, 95% CI: 0.941-1.895, = 0.106; Group III, aHR = 1.575, 95% CI: 1.122-2.210, = 0.009; Group IV, aHR = 2.803, 95% CI: 1.937-4.054, < 0.001).

Conclusions: Despite advanced techniques and medications for PCI in AMI, age still exerts a powerful influence in clinical outcomes. Careful approaches, even in the modern era of developed cardiology are needed for aged-population in AMI intervention.

Citing Articles

Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis.

Jalali A, Hassanzadeh A, Najafi M, Nayebirad S, Dashtkoohi M, Karimi Z BMC Geriatr. 2024; 24(1):337.

PMID: 38609875 PMC: 11015672. DOI: 10.1186/s12877-024-04896-4.

Influencing factors and prognostic value of left ventricular systolic dysfunction in patients with complete occlusion of the left anterior descending artery reperfused by primary percutaneous coronary intervention.

Jing Y, Lu C, Guo S, Chen B, Ye X, He Q BMC Cardiovasc Disord. 2023; 23(1):344.

PMID: 37430213 PMC: 10334541. DOI: 10.1186/s12872-023-03341-5.

Elderly Suffering from ST-Segment Elevation Myocardial Infarction-Results from a Database Analysis from Two Mediterranean Medical Centers.

Perl L, Franze A, DAscenzo F, Golomb N, Levi A, Vaknin-Assa H J Clin Med. 2021; 10(11).

PMID: 34070865 PMC: 8199382. DOI: 10.3390/jcm10112435.

Bioresorbable vascular stents and drug-eluting stents in treatment of coronary heart disease: a meta-analysis.

Ni L, Chen H, Luo Z, Yu Y J Cardiothorac Surg. 2020; 15(1):26.

PMID: 31992360 PMC: 6986072. DOI: 10.1186/s13019-020-1041-5.

References

Goldberg R, McCormick D, Gurwitz J, Yarzebski J, Lessard D, Gore J . Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975-1995). Am J Cardiol. 1998; 82(11):1311-7. DOI: 10.1016/s0002-9149(98)00633-x. View

Nebeker J, Virmani R, Bennett C, Hoffman J, Samore M, Alvarez J . Hypersensitivity cases associated with drug-eluting coronary stents: a review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. J Am Coll Cardiol. 2006; 47(1):175-81. DOI: 10.1016/j.jacc.2005.07.071. View

Serruys P, Silber S, Garg S, van Geuns R, Richardt G, Buszman P . Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med. 2010; 363(2):136-46. DOI: 10.1056/NEJMoa1004130. View

Yang X, Willems J, Pardaens J, De Geest H . Acute myocardial infarction in the very elderly. A comparison with younger age groups. Acta Cardiol. 1987; 42(1):59-68. View

Stone G, Grines C, Browne K, Marco J, Rothbaum D, Okeefe J . Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: the Primary Angioplasty in Myocardial Infarction (PAMI) trail. J Am Coll Cardiol. 1995; 25(2):370-7. DOI: 10.1016/0735-1097(94)00367-y. View

Silber S, Windecker S, Vranckx P, Serruys P . Unrestricted randomised use of two new generation drug-eluting coronary stents: 2-year patient-related versus stent-related outcomes from the RESOLUTE All Comers trial. Lancet. 2011; 377(9773):1241-7. DOI: 10.1016/S0140-6736(11)60395-4. View

Joner M, Finn A, Farb A, Mont E, Kolodgie F, Ladich E . Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006; 48(1):193-202. DOI: 10.1016/j.jacc.2006.03.042. View

Stettler C, Wandel S, Allemann S, Kastrati A, Morice M, Schomig A . Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet. 2007; 370(9591):937-48. DOI: 10.1016/S0140-6736(07)61444-5. View

Marroquin O, Selzer F, Mulukutla S, Williams D, Vlachos H, Wilensky R . A comparison of bare-metal and drug-eluting stents for off-label indications. N Engl J Med. 2008; 358(4):342-52. PMC: 2761092. DOI: 10.1056/NEJMoa0706258. View

10.

Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T . Guidelines on myocardial revascularization. Eur Heart J. 2010; 31(20):2501-55. DOI: 10.1093/eurheartj/ehq277. View

11.

Gurwitz J, Goldberg R, Gore J . Coronary thrombolysis for the elderly?. JAMA. 1991; 265(13):1720-3. View

12.

Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T . Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious?. Circulation. 2004; 109(6):701-5. DOI: 10.1161/01.CIR.0000116202.41966.D4. View

13.

Schofer J, Schluter M, Gershlick A, Wijns W, Garcia E, Schampaert E . Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomised controlled trial (E-SIRIUS). Lancet. 2003; 362(9390):1093-9. DOI: 10.1016/S0140-6736(03)14462-5. View

14.

Bavry A, Kumbhani D, Helton T, Bhatt D . Risk of thrombosis with the use of sirolimus-eluting stents for percutaneous coronary intervention (from registry and clinical trial data). Am J Cardiol. 2005; 95(12):1469-72. DOI: 10.1016/j.amjcard.2005.02.015. View

15.

Bavry A, Kumbhani D, Helton T, Bhatt D . What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention?: a meta-analysis. J Am Coll Cardiol. 2005; 45(6):941-6. DOI: 10.1016/j.jacc.2004.11.064. View

16.

Degeare V, Stone G, Grines L, Brodie B, Cox D, Garcia E . Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial.... Am J Cardiol. 2000; 86(1):30-4. DOI: 10.1016/s0002-9149(00)00824-9. View

17.

Lindsay Jr J, Reddy V, Pinnow E, Little T, Pichard A . Morbidity and mortality rates in elderly patients undergoing percutaneous coronary transluminal angioplasty. Am Heart J. 1994; 128(4):697-702. DOI: 10.1016/0002-8703(94)90267-4. View

18.

Topol E, Califf R . Thrombolytic therapy for elderly patients. N Engl J Med. 1992; 327(1):45-7. DOI: 10.1056/NEJM199207023270109. View

19.

De Gregorio J, Kobayashi Y, Albiero R, Reimers B, Di Mario C, Finci L . Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up. J Am Coll Cardiol. 1998; 32(3):577-83. DOI: 10.1016/s0735-1097(98)00287-3. View

20.

Kotani J, Awata M, Nanto S, Uematsu M, Oshima F, Minamiguchi H . Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J Am Coll Cardiol. 2006; 47(10):2108-11. DOI: 10.1016/j.jacc.2005.11.092. View