RESULTS OF ENDOVASCULAR REVASCULARIZATION IN ELDERLY PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION IN MULTIVESSEL DISEASE

Aim. To study the results of endovascular revascularization in older patients with ST elevation myocardial infarction (STEMI) in multivessel disease (MV).

Material and methods. Totally, 327 patients included. Inclusion criteria were: STEMI with duration <12 hours and primary PCI; hemodynamically significant (≥70%) lesion of 2 and more coronary arteries; technically possible percutaneous intervention (PCI). Criteria of exclusion: acute heart failure Killip III-IV (pulmonary edema and cardiogenic shock); left main stem lesion ≥50%. Patients were selected to 2 groups according to their age. To the 1st group we included elderly persons (age ≥65 y., n=103), to the second — patients younger than 64 y.o., n=224. Endpoints of the study were death, myocardial infarction (MI) (fatal and non-fatal), recurred non-scheduled target vessel revascularization, and the prevalence of combination endpoint. Evaluation of long-term results was done with clinical data collection during office visit or phone survey.

Results. The group of elderly patients was characterized by expectedly more severe comorbidities, usually having cardiovascular risks as associated diseases, had higher SYNTAX score, significantly higher 30-day and year mortality rates. Prevalence of three-vessel disease, as the usage of drug-coated stents and multivessel strategy (MS) under the primary PCI tactics, were comparable.

Conclusion. Sedentary patients were characterized by higher levels of mortality in acute myocardial infarction in hospital period, which makes significant to do more investigations for the development of optimal revascularization strategies in elderly patients having MV.

1. Gruzdev AA. Myocardial infarction in the elderly. Klin. Gerontologija 2010; 11-12: 14-7. Russian (Груздев А.А. Инфаркт миокарда у пожилых. Клиническая геронтология 2010, 11-12: 14-7).

2. Jan MF, Moiz-Hafiz A, Mori N, et al. Contemporary Door-to-Balloon Times With Primary Percutaneous Coronary Intervention in Elderly versus Younger Patients Presenting With Acute ST-Segment Elevation Myocardial Infarction. J Interv Cardiol. 2011 Aug; 24(4): 357-65. doi: 10.1111/j.

3. Buğan B, et al. Primary percutaneous coronary intervention in the elderly: catheterization or conservative approach? J Clin Anal Med 2014; 5(2): 164-7.

4. Jerlih AD, Gracianskij NA. Independent registry of acute coronary syndrome REKORD. Patients characteristics and in hospital treatment. Aterotromboz 2009; 1: 105-19 Russian (Эрлих А.Д., Грацианский Н.А. Независимый регистр острых коронарных синдромов РЕКОРД. Характеристика больных и лечение до выписки из стационара. Атеротромбоз. 2009; 1(2):105-19.

5. Windecker S, Kolh Ph, Alfonso F, et al. ESC/EACTS Guidelines on myocardial revascularization The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014; 35: 2541-619.

6. Altarev SS, Barbarash OL, Pomeshkina SA, et al. Predictors of Non-Fulfillment of Reperfusion Therapy in Patients With ST-Elevation Acute Coronary Syndrome. Kardiologija 2012; 6: 4-9 Russian (Алтерев С.С., Барбараш О.Л., Помешкина С.А. и др. Причины отказа от проведения реперфузионной терапии у пациентов с острым коронарным синдромом. Кардиология 2012; 6: 4-9).

7. Kochergina AM. Elderly patient with acute coronary syndrome. Issues and solutions. Ateroskleroz 2013; 3-4: 65-72. Russian (Кочергина А.М. Ведение пациентов пожилого и старческого возраста с острым коронарным синдромом. Проблемы и пути решения. Атеросклероз 2013; 3-4: 65-72).

8. United nations. [Электронный ресурс] URL: http://www.un.org (дата обращения 10.12.2014).

9. Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2005; 149 (1): 67-73.