Turgay IŞIK, Hüseyin UYAREL, Mehmet ERGELEN, Gökhan ÇİÇEK, Duygu Ersan DEMİRCİ, Mehmet GÜL, Ersin YILDIRIM, Abdurrahman EKSİK

Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları

Amaç: ST-segment yükselmeli miyokart infarktüsü (STYMİ) ile başvuran yaşlı hastalarda tedavi konusunda çelişkiler mevcuttru. Bu çalışmanın amacı, primer perkütan koroner girişimin (PKG) yaşlı hastalarda, hastane içi ve uzun dönem ters kardiyak olaylar üzerine etkisini araştırmaktır. Gereç ve yöntem: Ekim 2003 ile Mart 2008 tarihleri arasında primer PKG uygulanan, STYMİ olan 75 yaş ve üstü 220 hasta geriye dönük olarak araştırıldı. Hasta özellikleri, hastane içi ve uzun dönem olaylar kaydedildi. Bulgular: Hastaların erkek/kadın oranı 129/91 yaş ortalaması 78.7 ± 3.6 yıl (aralık, 75-97) idi. Hastaların %29.2’ sinde diyabet, %69.8’ inde hipertansiyon, %34.4’ ünde sigara kullanımı, %43.5’inde başvuru anında anemi mevcuttu. Hastaların %52.3’ünde anteriyor miyokard infarktüsü (Mİ) mevcuttu. Ortalama ağrı-balon süresi 222 ± 166 dakika idi. Hastaların%38.2’sinde üç damar hastalığı, %5.7’sinde başvuru anında kardiyojenik şok mevcuttu. Tüm hastalara ayrım yapılmaksızın primer PKG yapıldı ve işlem başarısı %79.6 olarak bulundu. Hastaların %79’una stent takıldı. Hastane içi kalp yetersizliği hastaların %27.7’sinde mevcuttu. İntra-Aortik Balon Pump %14.5’inde kullanıldı. Farklı yaş gruplarındaki hastalar arasında hastane içi ve uzun dönem Major Kardiyak Olumsuz Olay (MKOO) açısından fark gözlenmedi. Hastaların %20.9’unda hastane içi MKOO gözlendi. Diyabet, başvuru anı lölosit sayısı ve hastane içi konjestif kalp yetersizliği olması hastane içi MKOO’ın bağımsız belirleyicileri idi. Ortalama bir yıl takibi yapılan hastaların (0-53 ay) %28’ inde MKOO gözlendi. Başvuru sırasındaki hemoglobin düşüklüğü ve doruk–CKMB düzeyi uzun dönem takipte MKOO’nun bağımsız belirleyiciler olarak bulundu. Sonuç: Primer anjiyoplasti STYMİ ile başvuran 75 yaş ve üzeri hastalarda düşük işlem komplikasyon insidansı, yüksek işlem başarısı, yüksek kısa ve uzun dönem sağ kalım ile birlikte görünmektedir.

Short and long term outcomes of primary angioplasty in patients aged 75 years and over

Objectives: The treatment of elderly patients with ST segment elevated myocardial infarction (STEMI) remains controversial. This study aimed to investigate the effects of primary angioplasty in elderly patients on in-hospital and long term major adverse cardiac events (MACE). Materials and methods: From October 2003 to March 2008, we retrospectively enrolled 220 patients aged 75 years and over with STEMI who underwent primary angioplasty. Patients’ characteristics, in-hospital and long term events were recorded. Results: Male/Female ratio of patients was 129/91 and mean age was 78.7 ± 3.6 (range, 75-97) years, and 58.6% of male). Of these patients 29.2% were diabetics, 69.8% were hypertensive, 34.4% were smoker and 43.5% were anemic at admission. Anterior myocardial infarction was diagnosed in 52.3% of patients. Mean pain-balloon time was 222 ± 116 minutes. Eighty two (38.2%) of these 220 patients had three-vessel disease and 12 (5.7%) were diagnosed as cardiogenic shock. Procedural success was observed in 79.6% of patients. Heart failure was observed 27.7% in hospital and intra aortic pump was used in 14.5% of patients. There was no significant difference between age groups in long term major cardiac events and in hospital mortality. Diabetes, leukocyte count at admission and in hospital heart failure were independent predictors of short term MACE and low hemoglobin level at admission and peak CKMB levels were independent predictors of long term MACE. Conclusions: Primary angioplasty in patients aged 75 years and over seems to be associated with low procedural complication, high procedural success, improved short and long term survival.

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