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European Heart Journal Advance Access published online on January 28, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi110
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty

Giuseppe De Luca 1, Arnoud W.J. van t'Hof 1, Jan Paul Ottervanger 1, Jan C.A. Hoorntje 1, A. T. Marcel Gosselink 1, Jan-Henk E. Dambrink 1, Menko-Jan de Boer 1, and Harry Suryapranata 1*

1 Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Groot Weezelanden 20, 8011 JW Zwolle, The Netherlands

* To whom correspondence should be addressed.
Harry Suryapranata, E-mail: h.suryapranata{at}diagram-zwolle.nl


  Abstract

Aims It is still unknown whether impaired myocardial perfusion helps to explain the higher mortality observed with ageing in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty.

Methods and results In 1548 consecutive patients with STEMI treated with primary angioplasty, myocardial perfusion was evaluated by myocardial blush grade (MBG) and ST-segment resolution. All clinical and follow-up data were prospectively collected. Advanced age was associated with a significantly higher clinical and angiographic risk profile. We found a linear relationship between increasing age, decreased myocardial perfusion, and higher 1-year mortality. After adjustment for baseline potential confounding variables, increased age was still significantly associated with impaired myocardial blush (MBG 0-1) (P = 0.028), and ST-segment resolution (<50%) (P = 0.007). At multivariable analysis both age (P < 0.0001) and poor myocardial perfusion (P < 0.0001) were independent predictors of 1-year mortality.

Conclusion This study shows that impaired reperfusion is an additional determinant of the poor outcome observed with advanced age in patients with STEMI undergoing mechanical revascularization.

Keywords: Primary angioplasty; Perfusion; Ageing; Mortality.
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