Clinics (Jun 2009)

The role of invasive therapies in elderly patients with acute myocardial infarction

  • José C. Nicolau,
  • Pedro A. Lemos,
  • Maurício Wajngarten,
  • Roberto R. Giraldez,
  • Carlos V. Serrano Jr.,
  • Eulógio E. Martinez,
  • Luciano M. Baracioli,
  • Roberto Kalil,
  • Fábio B. Jatene,
  • Luis A. Dallan,
  • Luis B. Puig,
  • Noedir A. Stolf

DOI
https://doi.org/10.1590/S1807-59322009000600010
Journal volume & issue
Vol. 64, no. 6
pp. 553 – 560

Abstract

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INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were >70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.

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