Transfer for primary angioplasty in elderly patients with acute myocardial infarction

Abstract

Introduction: The aim of this study was the evaluation of an immediate transfer for primary angioplasty (PPCI) in elderly (age ≥ 75 years) patients with ST elevation acute myocardial infarction (STEMI). Methods and materials: All elderly patients with STEMI admitted for PPCI from June 2002 to October 2005, were enrolled. Major Adverse Cardiac Events (MACE) were collected at 6 months. Results: 133 patients (group 1) were admitted directly and 154 patients (group 2) were transferred from peripheral hospitals. Ischemia time was 248±146min in group 1 and 276±169min in group two (P<0.001); door-to-balloon time was 60±30 min in group 1 and 90±45 min in group two (P<0.0001). At 6 months cardiac death occurred in 15 (11%) and 16 (10%) patients in group 1 and 2 respectively (P=NS), MI in 3(2%) and 2(1%) respectively (P=NS), clinically driven target lesion revascularization in 6(4%) and 5(3%) respectively, for an overall event-free survival rate of 82% in group 1 and 83% in group 2 (P=NS). Logistic regression analysis showed age (OR: 1.04.1; 95% CI: 1.0–1.2; P=0.049) Killip class ≥2 (OR: 4.6; 95% CI: 1.3–16.4; P=0.01) to be the only independent predictors of 6-month cardiac mortality. Conclusion: Systematic transfer of elderly STEMI patients for PPCI, with a door-to-balloon time <1 h, leads to clinical results similar to those achievable in patients who present directly in hospital with cath.-lab. facilities.

• Primary angioplasty
• elderly
• STEMI
• clinical outcome