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Comparison of epicardial and myocardial perfusions after primary coronary angioplasty for ST-elevation myocardial infarction in patients under and over 75 years of age

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Abstract

Background and aims: Patients aged ≥75 years compose a high-risk subgroup for acute myocardial infarction (AMI). It is unknown whether myocardial perfusion in these patients is decreased compared with younger ones after primary percutaneous coronary intervention (PPCI), which may contribute to their worse prognosis. We compared epicardial and myocardial perfusions as well as short-term outcomes between elderly and younger patients undergoing PPCI. Methods: A total of 547 consecutive PPCI patients were prospectively enrolled; of these, 106 were elderly (≥75 yrs). Epicardial perfusion was evaluated by the Thrombolysis in Myocardial Infarction (TIMI) flow grade and corrected TIMI frame count (CTFC), and myocardial perfusion was evaluated by the TIMI myocardial perfusion grade (TMPG) and ST-segment resolution (STR). Results: Despite comparable epicardial perfusion pre- and post-PPCI, elderly patients had impaired myocardial perfusion after PPCI, as measured by reduced TMPG (35.9% vs 14.5%, p=0.001) and absent STR (18.9% vs 9.8%, p=0.009). After adjusting for clinical and angiographic risk profiles, multivariate analysis showed that age ≥75 years remained independently associated with reduced TMPG or absent STR. In the whole population, multivariate analysis revealed that both age ≥75 years and absent STR were independently associated with 3-month major adverse cardiac events (MACE). In the elderly subgroup, multivariate analysis identified absent STR as the strongest determinant of 3-month MACE. Conclusions: Age is associated with impaired myocardial perfusion, but not epicardial perfusion, after PPCI for AMI. To further improve the outcome of elderly AMI patients, efforts should be aimed at improving myocardial perfusion beyond epicardial recanalization.

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Authors and Affiliations

  1. Department of Cardiology, School of Medicine, Shanghai Renji Hospital, Shanghai Jiaotong University, 1630 Dongfang Road, Shanghai, 200127, China

    Jun Pu, Song Ding, Peiren Shan, Zhiqin Qiao, Wei Song, Yongping Du, Jieyan Shen, Shuxuan Jin & Ben He MD, PhD, FACC

  2. Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China

    Peiren Shan

Authors
  1. Jun Pu
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  2. Song Ding
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  3. Peiren Shan
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  4. Zhiqin Qiao
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  5. Wei Song
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  6. Yongping Du
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  7. Jieyan Shen
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  8. Shuxuan Jin
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  9. Ben He MD, PhD, FACC
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Corresponding author

Correspondence to Ben He MD, PhD, FACC.

Additional information

This work was in part presented at the 2008 European Society Cardiology Congress (Munich, Germany, August 30, 2008).

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Pu, J., Ding, S., Shan, P. et al. Comparison of epicardial and myocardial perfusions after primary coronary angioplasty for ST-elevation myocardial infarction in patients under and over 75 years of age. Aging Clin Exp Res 22, 295–302 (2010). https://doi.org/10.1007/BF03337726

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  • DOI: https://doi.org/10.1007/BF03337726

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