Circulation, Vol 90, 78-86, Copyright © 1994 by American Heart Association
FV Aguirre, RP McMahon, H Mueller, NS Kleiman, MJ Kern, P Desvigne-Nickens, WP Hamilton and BR Chaitman
BACKGROUND: Few thrombolytic studies have assessed whether patient age is
an indication for routine postlytic cardiac catheterization and
revascularization or evaluated the impact of age on 1-year outcome
differences after acute myocardial infarction. METHODS AND RESULTS: A
secondary analysis of 3339 patients enrolled in the TIMI II trial was
performed to identify differences in clinical and coronary angiographic
findings and 1-year cardiac event rates among 841 patients < 50 years
old, 1639 patients 50 to 64 years old, and 859 patients 65 to 75 years old.
Differences in 1-year clinical outcome were assessed among patients
randomly assigned to an invasive or a conservative postlytic strategy
within each age group. The percentages of patients with a prior history of
myocardial infarction, angina, congestive heart failure, hypertension, or
diabetes mellitus or an infarction complicated at the time of study entry
by shock, pulmonary edema, hypotension, rales more than one third of lung
fields, or atrial fibrillation as well as the percentage of female patients
(all P < .001) increased with age. Fewer older patients (65 to 75 years)
received early (ie, < or = within 2 hours after symptom onset) treatment
with recombinant tissue-type plasminogen activator (rTPA), and fewer were
eligible for random assignment to immediate or deferred beta-blocker
therapy (P = .01). The location of the infarct-related artery and the
percentage of patients with patent (ie, TIMI flow grade 2 or 3) or
"complete" (ie, TIMI flow grade 3) infarct-related artery flow did not vary
with age. The percentage of patients with multivessel disease was greatest
in the older patients (P = .001). Cumulative 1- year mortality was low in
the youngest patients (2.8%; 99% confidence interval [CI], 1.6% to 4.7%)
regardless of whether the infarct location was anterior (3.7%) or
nonanterior (1.6%). The highest 1-year mortality occurred in the older
patients (13.6%; 99% CI, 10.9% to 16.9%), particularly when the infarct
location was anterior (18%). The 42-day rates of reinfarction (P = .85),
death (P = .95), or death or reinfarction (P = .99) were similar in
patients assigned to the invasive or conservative postlytic treatment
strategy, regardless of age group. CONCLUSIONS: Among patients with acute
myocardial infarction treated with intravenous rTPA, heparin, and aspirin,
there were age- related differences in time to treatment with thrombolytic
therapy, use of beta-blockers, extent of coronary artery disease, and
1-year cardiac event rates. Routine use of cardiac catheterization and
coronary revascularization does not improve immediate or 1-year outcome in
terms of mortality or reinfarction compared with a more conservative
strategy in young, middle-aged, or elderly patients similar to those
enrolled in TIMI II.
ARTICLES
Impact of age on clinical outcome and postlytic management strategies in patients treated with intravenous thrombolytic therapy. Results from the TIMI II Study. TIMI II Investigators
St Louis University Hospital, St Louis University Health Sciences Center, MO 63110.
This article has been cited by other articles:
 |
|
 |
|
  T. Kinnaird, E. Stabile, S. Zbinden, M.-S. Burnett, and S. E. Epstein Cardiovascular risk factors impair native collateral development and may impair efficacy of therapeutic interventions Cardiovasc Res, May 1, 2008; 78(2): 257 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Lehrke, R. Mazhari, D. J. Durand, M. Zheng, D. Bedja, J. M. Zimmet, K. H. Schuleri, A. S. Chi, K. L. Gabrielson, and J. M. Hare Aging Impairs the Beneficial Effect of Granulocyte Colony-Stimulating Factor and Stem Cell Factor on Post-Myocardial Infarction Remodeling Circ. Res., September 1, 2006; 99(5): 553 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. P. Schulman, L. C. Becker, D. A. Kass, H. C. Champion, M. L. Terrin, S. Forman, K. V. Ernst, M. D. Kelemen, S. N. Townsend, A. Capriotti, et al. L-Arginine Therapy in Acute Myocardial Infarction: The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial JAMA, January 4, 2006; 295(1): 58 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G. Lakatta and S. Schulman Age-associated cardiovascular changes are the substrate for poor prognosis with myocardial infarction J. Am. Coll. Cardiol., July 7, 2004; 44(1): 35 - 37. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Edelberg, L. Tang, K. Hattori, D. Lyden, and S. Rafii Young Adult Bone Marrow-Derived Endothelial Precursor Cells Restore Aging-Impaired Cardiac Angiogenic Function Circ. Res., May 31, 2002; 90 (10): e89 - e93. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Gould, G. E. Taffet, L. H. Michael, R. M. Christie, D. L. Konkol, J. S. Pocius, J. P. Zachariah, D. F. Chaupin, S. L. Daniel, G. E. Sandusky Jr., et al. Heart failure and greater infarct expansion in middle-aged mice: a relevant model for postinfarction failure Am J Physiol Heart Circ Physiol, February 1, 2002; 282(2): H615 - H621. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Schulman, D. S. Latchman, and D. M. Yellon Effect of aging on the ability of preconditioning to protect rat hearts from ischemia-reperfusion injury Am J Physiol Heart Circ Physiol, October 1, 2001; 281(4): H1630 - H1636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
|
|
|
|
 |
|
 N G Mahon, C O'Rorke, M B Codd, H A McCann, K McGarry, and D D Sugrue Hospital mortality of acute myocardial infarction in the thrombolytic era Heart, May 1, 1999; 81(5): 478 - 482. [Abstract] [Full Text]
|
|
|
|
|
|
D. R. Holmes Jr., H. D. White, K. S. Pieper, S. G. Ellis, R. M. Califf, and E. J. Topol Effect of age on outcome with primary angioplasty versus thrombolysis J. Am. Coll. Cardiol., February 1, 1999; 33(2): 412 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Grepin, G Nemer, and M Nemer Enhanced cardiogenesis in embryonic stem cells overexpressing the GATA-4 transcription factor Development, January 6, 1997; 124(12): 2387 - 2395. [Abstract] [PDF]
|
|
|
|
 |
|
 D. D. Tresch, W. J. Brady, T. P. Aufderheide, S. W. Lawrence, and K. J. Williams Comparison of Elderly and Younger Patients With Out-of-Hospital Chest Pain Arch Intern Med, May 27, 1996; 156(10): 1089 - 1093. [Abstract] [PDF]
|
|