THE REDUCTION OF HOSPITAL MORTALITY OF MYOCARDIAL INFARCTION IN «PROBLEM GROUPS» – FOCUS ON PATIENTS OVER 75 YEARS

The purpose. The aim of the study was to analyze immediate results of acute myocardial infarction’s treatment in patients older than 75 and to estimae the effectiveness of percutaneous coronary interventions (PCI).

Materials and methods: 208 cases of acute myocardial infarction (AMI) in patients older than 75 were reviewed in the study. The control group consisted of 85 (40.9%) cases of emergency primary PCI. For comparison, there was a group of patients who underwent the conservative treatment (123 (59,1%) cases).

Results. All the patients in the study regardless of AMI’s treatment were characterized by the following clinical features (p>0.05): high prevalence of cardiovascular and significant somatic diseases, late treatment onset, severe hemodynamically significant pathology of the coronary arteries not only according to the number of affected vessels but also by SYNTAX scale. In general, 123 (59,1%) cases of urgent (emergency and delayed) coronary angiography were performed. The coverage of diagnostic interventions in patients with conservative treatment was 38 (30,9%) cases. This number had statistically significant difference with the PCI group (p<0.05). The advantages of PCI (p<0.05) were obtained for mortality (12,9% – 25,2%) and duration of hospital stay (13,6±0,3 days – 15.43±0.4 days).

Conclusion. Reduction of mortality in AMI patients older than 75 is associated with an increase of emergency coronary stenting in the structure of medical activities. Specific complications of PCI are rare, which proves the safety of this method of reperfusion therapy among patients of this age. Patient’s age over 75 years old should not be considered as a limitation for coronary angiography and subsequent stenting.

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