ABSTRACT
INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were ¡Ý70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients.
Subject(s)
Aged , Female , Humans , Male , Angioplasty, Balloon, Coronary/mortality , Coronary Artery Bypass/mortality , Myocardial Infarction/therapy , Age Factors , Follow-Up Studies , Long-Term Care , Myocardial Infarction/mortality , Prospective Studies , Sex Factors , Survival Rate , Treatment OutcomeABSTRACT
No Hospital da Beneficência Portuguesa, Serviço do Prof. Dr. Luís B. Puig, 30 pacientes foram submetidos a revascularizaçao do miocárdio, no período de novembrode 1991 a março de 1992. Quinze pacientes receberam uma artéria torácica interna (Grupo I) e complementaçao com pontes de veia safena e os outros l5 pacientes receberam duas artérias torácicas internas (Grupo II) e complementaçâo com pontes de veia safena. Nao havia diferenças nos dois grupos, quanto aos antecedentes patológicos e às condiçoes clínicas pré-operatórias. No Grupo I foi realizada uma média de 2,4 por cento enx./paciente e no Grupo II, 3,1 por cento. No período pós-operatório imediato, nao houve diferenças nos dois grupos, quanto a incidência de reoperaçoes por sangramento, infarto trans-operatório, ou presença de atelectasia pulmonar. Houve um óbito (3,3 por cento) no Grupo I, devido a acidente vascular cerebral. Treze pacientes foram submetidos a estudo hemodinâmico pós-operatório antes da alta hospitalar, sendo seis no Grupo I e sete no Grupo II. As 13(1OO por cento) artérias torácicas internas esquerdas e as 7(1OO por cento) artérias direitas estavam pérvias. No Grupo II a artéria direita foi utilizada para revascularizar a artéria marginal esquerda em cinco pacientes e o ramo dialgonalis em dois. OS resultados sugerem que a artéria torácica interna direita deve ser usada mais freqüentemente e talvez tenha sua melhor aplicaçao por via retro-aórtica direcionada para o ramo marginal esquerdo.