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The Impact of Advanced Age on Major Cardiovascular Events and Mortality in Patients with ST-Elevation Myocardial Infarction Undergoing a Pharmaco-Invasive Strategy.
Helber, Izo; Alves, Claudia Maria Rodrigues; Grespan, Stela Maris; Veiga, Eduardo C A; Moraes, Pedro I M; Souza, José Marconi; Barbosa, Adriano H; Gonçalves, Iran; Fonseca, Francisco A H; Carvalho, Antônio Carlos C; Caixeta, Adriano.
Afiliación
  • Helber I; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Alves CMR; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Grespan SM; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Veiga ECA; Department of Gynecology and Obstetrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • Moraes PIM; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Souza JM; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Barbosa AH; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Gonçalves I; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Fonseca FAH; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Carvalho ACC; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
  • Caixeta A; Department of Medicine, Discipline of Cardiology, Escola Paulista de Medicina, Universidade Federal São Paulo, São Paulo, Brazil.
Clin Interv Aging ; 15: 715-722, 2020.
Article en En | MEDLINE | ID: mdl-32546989
BACKGROUND: There is little research in the efficacy and safety of a pharmaco-invasive strategy (PIS) in patients ≥75 years versus <75 years of age. We aimed to evaluate and compare the influence of advanced age on the risk of death and major adverse cardiac events (MACE) in patients undergoing PIS. METHODS: Between January 2010 and November 2016, 14 municipal emergency rooms in São Paulo, Brazil, used full-dose tenecteplase to treat patients with STEMI as part of a pharmaco-invasive strategy for a local network implementation. RESULTS: A total of 1852 patients undergoing PIS were evaluated, of which 160 (9%) were ≥75 years of age. Compared to patients <75 years, those ≥75 years were more often female, had lower body mass index, higher rates of hypertension; higher incidence of hypothyroidism, chronic renal failure, prior stroke, and diabetes. Compared to patients <75 years of age, in-hospital MACE and mortality were higher in patients with ≥75 years (6.5% versus 19.4%; p<0.001; and 4.0% versus 18.2%; p<0.001, respectively). Patients ≥75 years had higher rates of in-hospital major bleeding (2.7% versus 5.6%; p=0.04) and higher incidence of cardiogenic shock (7.0% versus 19.6%; p<0.001). By multivariable analysis, age ≥75 years was independent predictor of MACE (OR 3.57, 95% CI 1.72 to 7.42, p=0.001) and death (OR 2.07, 95% CI 1.12-3.82, p=0.020). CONCLUSION: In patients with ST-segment elevation myocardial infarction undergoing PIS, age ≥75 years was an independent factor that entailed a 3.5-fold higher MACE and 2-fold higher mortality rate compared to patients <75 years of age.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fármacos Cardiovasculares / Mortalidad / Infarto del Miocardio con Elevación del ST Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Clin Interv Aging Asunto de la revista: GERIATRIA Año: 2020 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Nueva Zelanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fármacos Cardiovasculares / Mortalidad / Infarto del Miocardio con Elevación del ST Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Clin Interv Aging Asunto de la revista: GERIATRIA Año: 2020 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Nueva Zelanda