Téma: 

Is there any difference in clinical and angiographic profile of young and elderly patients with myocardial infarctiopercutanneous coronary intervention?

František Kovář, Jaroslav Podmanický, Roman Alberty, Roman Margóczy, Peter Mečiar, Peter

Aim: To compare clinical profile, findings on urgent coronarographyc and early course in patients with STEMI at young and old age. Patients and methods: retrospective analysis of patients in 2 age groups: up to 50 yrs (group A) and over 75 yrs (group B) who underwent urgent coronarography for STEMI. History, coronarographic findings, function of left ventricle, therapy and hospital mortality were evaluated. Results: the followed - up at our work place, there were hospitalized during evaluated period of time in our department for STEMI in group A 90 pts.at the age of 26-50 (mean age 44.6) years and 87 pts. in group B at the age of 75-89 (mean 78.3) years. In the group of younger patients the ratio of males was 79 (87.7 %) vs 39 (448 %) (p < 0.001), positive family history of cardiovascular diseases was in group A in 55(61.1 %) vs 25 (28.7 %) pts., p < 0.001. Presence of hypertension was in group A in 36 (40 %) and in group B in 61 (70.1 %) pts., p < 0.001 and diabetes mellitus in 6 (6.7 %) vs 26 (29.9 %) pts., p < 0.001. In group A there were 68 (75.6 %) smokers vs 13 (14.9 %) pts. In group B (p < 0.001).Ten patients (11.1 %) in group A were after myocardial infarction, in group B 18 patients (20.7 %) pts., p=0.036 and 2 (2.2 %) vs 24 (27.6 %) pts. after stroke, p < 0.01. Lesion of 1 vessel on coronography was evaluated in 47 (52.2 %) pts. in group A vs 21 (24.1 %) in group B (p < 0.001). Average LVEF achieved 48 % in group A vs 41 % in group B (p < 0.001). 79 (87.8 %) pts. in group A and 71 (81.6 %) pts .in group B underwent direct PCI, p=ns, conservative therapy was applied in 11 (12.2 %) pts. in group A vs 16 (18.4 %) in group B, p=ns. Death during hospitalization was reported in group A in 3 pts. (3.3 %) vs 12 pts. (13.4 %) in group B (p=0.01). Conclusion: Patients with STEMI at the age over 75 years represent a risk group with significant comorbidity and frequent findings of multivascular lesions of coronary bed at initial coronarography. Compared with patients treated for STEMI at the age of 50 years they have history of myocardial infarction or stroke in the past. This risk profile reflects worse global systolic function of the left ventricle and higher hospital mortality after direct PCI.

Ročník 2007  Témy časopisu Internal medicine 11 / 2007

CHAIRMAN OF THE EDITORIAL BOARD
prof. MUDr. Ivica Lazúrová, CSc. FRCP

REPRESENTATIVE OF CHAIRMAN
prof. MUDr. Juraj Payer, CSc., FRCP

MEMBERS OF THE EDITORIAL BOARD
doc. MUDr. Viera Fábryová, CSc.
MUDr. Viera Fedelešová, CSc.
prof. MUDr Martin Haluzík, CSc.
prof. MUDr. Štefan Hrušovský, CSc. Dr.SVS.
prof. MUDr. Rudolf Hyrdel, CSc.
doc. MUDr. Oľga Jurkovičová, CSc.
doc. MUDr. Zdenko Killinger, PhD.
doc. MUDr. Soňa Kiňová, PhD.
prof. MUDr. Peter Mitro, PhD.
doc. MUDr. Viliam Mojto, CSc., MHA
prof. MUDr. Karel Pacák, DrSc.
prof. MUDr. Juraj Payer, CSc., FRCP
doc. MUDr. Ján Podoba, CSc.
prof. MUDr. Igor Riečanský, DrSc.
doc. MUDr. Ján Staško, PhD.
doc. MUDr. Mária Szántová, PhD.
prof. MUDr. Ivan Tkáč, PhD.

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3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
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