0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Coronary Revascularization after Myocardial Infarction in the Very Elderly: Outcomes and Long-Term Follow-up

Harlan M. Krumholz, MD; Daniel E. Forman, MD; Richard E. Kuntz, MD; Donald S. Baim, MD; and Jeanne Y. Wei, MD
[+] Article and Author Information

From the Charles A. Dana Research Institute and Harvard Medical School, Boston, and the GRECC Brockton/West Roxbury Veterans Affairs Medical Center, West Roxbury, Massachusetts. Requests for Reprints: Harlan M. Krumholz, MD, Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510-8056. Acknowledgments: The authors thank Drs. Lee Goldman, Daniel Levy, Gottlieb C. Friesinger II, Ralph Horwitz, Barry L. Zaret, and Lawrence S. Cohen for their comments on the manuscript; and Dr. Charles Safran for his help with ClinQuery. Grant Support: In part by the National Heart, Lung, and Blood Institute Cardiovascular Research Training Grant HL-07374.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(11):1084-1090. doi:10.7326/0003-4819-119-11-199312010-00005
Text Size: A A A

Objective: To determine the outcome of very elderly patients who had coronary revascularization during hospitalization for an acute myocardial infarction.

Design: Retrospective cohort study.

Setting: Community-based tertiary-care teaching hospital.

Patients: A total of 1215 consecutive patients 80 years and older were hospitalized with a myocardial infarction between 1985 and 1990. The study sample included all 93 patients (8%) who had cardiac catheterization before discharge and had not been excluded from study because of the following: severe valvular disease, absence of significant coronary disease, or death before a decision about revascularization could be made.

Measurements: Survival, quality of life, and functional status at least 1 year after discharge.

Results: After catheterization, 41 patients had angioplasty, 18 had coronary artery bypass surgery, and 34 did not have revascularization. Among the patients alive at discharge, those who had revascularization had a high likelihood of achieving a good or excellent quality of life (angioplasty, 86% [31 of 36]; surgery, 89% [16 of 18]; medical therapy, 44% [11 of 25]) and of being able to care for themselves (angioplasty, 89% [32 of 36], surgery, 89% [16 of 18], medical therapy, 52% [13 of 25]). Mortality rates at 1 year were 24% (95% CI, 15% to 47%) for the angioplasty group, 6% (CI, 0% to 27%) for the surgery group, and 44% (CI, 27% to 62%) for the medical therapy group. In a Cox proportional-hazards model that adjusted for clinical, demographic, hemodynamic, and anatomic differences between the groups, the performance of coronary revascularization was associated with increased survival (hazard ratio, 0.42; CI, 0.18 to 0.98).

Conclusions: A small percentage of very elderly patients with complicated acute myocardial infarctions, selected by their physicians for invasive cardiovascular procedures, can tolerate these procedures, avoid serious complications, return to independent living, and have excellent probability of survival. Although our results suggest that coronary revascularization may have benefited these patients, the study design did not permit definite conclusions, and future studies are needed to resolve this important question.

Figures

Grahic Jump Location
Figure 1.
Kaplan-Meier plot of the survival for the 79 patients who survived the hospitalization.

Patients were stratified by revascularization strategy. The number of patients at risk at each time point is indicated. CABG = coronary artery bypass graft; PTCA = percutaneous transluminal coronary angioplasty; Rx = therapy.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Kaplan-Meier plot of the survival for the 38 patients who survived the hospitalization and had an ejection fraction of 0.

55 or greater. Patients were stratified by revascularization strategy. The number of patients at risk at each time point is indicated. CABG = coronary artery bypass graft; PTCA = percutaneous transluminal coronary angioplasty; Rx = therapy.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Kaplan-Meier plot of the survival for the 39 patients who survived the hospitalization and had an ejection fraction of less than 0.

55. Patients were stratified by revascularization strategy. The number of patients at risk at each time point is indicated. CABG = coronary artery bypass graft; PTCA = percutaneous transluminal coronary angioplasty; Rx = therapy.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)