| 이석, 정명호, 홍영준, 안영근, 황선호, 윤남식, 이상록, 홍서나, 김계훈, 박형욱, 김주한, 조정관, 박종춘, 강정채, 박옥규 |
Background: Age-related differences in patients with an acute myocardial infarction (AMI) have not been well characterized.
Methods: A total of 105 patients with AMI who underwent percutaneous coronary intervention were included and we divided them into two groups: Group I (age<50, n=49) and Group II (age>70, n=56). We compared clinical findings and major adverse cardiovascular events during 12-month follow-up.
Results: There was a female predominance (20.4% vs. 55.4%, p<0.001) and more patients had a history of hypertension (27.7% vs. 62.5%, p<0.001) in Group II. The baseline left ventricular ejection fraction was significantly lower and cardiogenic shock was observed more frequently in Group II (56±11% vs. 49±15%, p=0.011 and 0% vs. 14.3%, p=0.006). Multivessel disease and left main lesion were observed more frequently in Group II (44.9% vs. 64.3%, p=0.008 and 4.1% vs. 23.2%, p=0.004). The baseline erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and homocysteine levels were significantly higher in Group II (18±20 vs. 29±22 mg/dl, p=0.009, 1.8±2.1 vs. 3.3±3.7 mg/dl, p=0.016, 10.8±4.2 vs. 13.3±3.8 mg/dl, p=0.017, respectively). Follow-up coronary angiography was performed less frequently in Group II (87.8% vs. 35.7%, p<0.001) and follow-up ESR, CRP, and homocysteine levels were higher in Group II (8±10 vs. 23±21 mg/dl, p<0.009, 0.4±0.3 vs. 0.9±1.2 mg/dl, p=0.009, 11.7±4.2 vs. 15.5±6.6 mg/dl, p=0.022, respectively). There were no significant differences in the incidence of myocardial infarction, cerebrovascular accident, and target vessel revascularization between both groups, however, cardiac death occurred more frequently in group II (0% vs. 10.7%, p=0.018) at 12-month clinical follow-up.
Conclusion: Elderly AMI patients had more cardiogenic shock and complex coronary lesions and were associated with higher levels of inflammatory markers and had higher 12-month mortality. Our findings emphasize intensive anti-inflammatory therapy as well as early aggressive intervention is needed for elderly patients with AMI.
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