| Background: With the aging population in the society, older patients constitute a substantial minority of patients with acute myocardial infarction (AMI). The mortality of these patients is high and they belong to high-risk group. Because these patients always have thrombolysis contraindications and the incidence of complications, such as stroke, is relatively high, elderly patients with acute ST elevated myocardial infarction (STEMI) are limited to be treated with fibrinolytic therapy. At present there was still no large scale clinical trial evaluating the safety and efficacy of emergency percutaneous coronary intervention (PCI) in elderly STEMI patients. Objectives: This study sought to evaluate the efficacy of emergency PCI in elderly patients with acute STEMI. Patients and methods: 1. Study Patients: From January 2002 to December 2004, 58 patients aged 65 years or above who were first time diagnosed as STEMI underwent emergency PCI. Of these, 27 patients (elderly group) were 75 years or above (mean age 78±2.75 years, 18 men and 9 women) and 31 patients (non-elderly group) were younger than 75 years (mean age 67.9±4.1 years, 23 men and 8 women) 2.Emergency PCI: Coronary angiography (CAG) was performed via the femoral approach to determine infarct-related artery (IRA).Then primary PTCA plus coronary stenting or direct coronary stenting were accomplished to intervene IRA. Patients were routinely treated with aspirin and clopidogrel before CAG, intravenous heparin during procedure. Arterial sheath was removed after 4 hours following procedure and then hypodermic LMWH was begining to be given 2 hours later. The dose of other secondary prevention medications was no difference between two groups. A successful acute angiographic result was defined as a residual stenosis of less than 20% associated with TIMI grade 3 flow. A successful revascularization procedure was defined as no major adverse cardiac events such as death, reinfartion and emergency CABG happening during hospitalization. 3. Observation Index: The observation index included complication associated with PCI such as puncture site haematoma and cardiovascular events such as unstable angina, cardiac insufficiency, arrhythmia, reinfartion, emergency CABG and death during hospitalization. 4. Statistical Analysis: The chi-Square test or Fisher exact test analysis was used to compare categoric variables. A 2-tailed Student t test was used to test differences among continuous variables. Statistical tests were performed by using SPSS 11.5 and SAS8.0. A P value of less than .05 was considered significant. Results: 1. Baseline Clinical Characteristics: There was no significant difference in female sex, the incidence of hyperlipemia, diabetes, hypertension and the location of AMI between two groups. The incidence of in-hospital cardiovascular events in those with comorbid illness was greater than those without comorbid illness (elderly group: 55.56% vs. 33.33%; non-elderly group: 36.37% vs. 33.33%), but these differences did not reach statistical significance. 2.Angiographic Characteristics: In both groups LAD was he leading IRA, followed by RCA and then LCX. There was no significant difference in the distribution of IRA between two groups. The only significantdifference in the angiographic characteristics between elderly group and non-elderly group was a greater incidence of 2 vessel diseases in the former group (44.44% vs 19.35%, P =0.04). There was no significant difference in the incidence of 1 and 2 vessel diseases between two groups. The incidence of in-hospital cardiovascular events in those of multiple vessel diseases was greater than those of 1 vessel disease (elderly group: 52.17% vs. 25%; non-elderly group: 36.37% vs. 33.33%), but these differences did not reach statistical significance. 3.Efficacy of Emergency PCI: The mean time of symptom onset to balloon inflation was 5.48±3.31 hours in elderly group and 6.13±3.52 hours in non-elderly group, in which there was no significant difference between two groups. The rate of angiographic succes...
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