Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction – A cardiac magnetic resonance imaging study
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Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction – A cardiac magnetic resonance imaging study. / Gabriel Topal, Divan; Aleksov Ahtarovski, Kiril; Lønborg, Jacob; Høfsten, Dan; Nepper-Christensen, Lars; Kyhl, Kasper; Schoos, Mikkel; Ghotbi, Adam Ali; Göransson, Christoffer; Bertelsen, Litten; Holmvang, Lene; Helqvist, Steffen; Pedersen, Frants; Schnabel, Renate; Køber, Lars; Kelbæk, Henning; Vejlstrup, Niels; Engstrøm, Thomas; Clemmensen, Peter.
I: IJC Heart and Vasculature, Bind 33, 100731, 04.2021.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction – A cardiac magnetic resonance imaging study
AU - Gabriel Topal, Divan
AU - Aleksov Ahtarovski, Kiril
AU - Lønborg, Jacob
AU - Høfsten, Dan
AU - Nepper-Christensen, Lars
AU - Kyhl, Kasper
AU - Schoos, Mikkel
AU - Ghotbi, Adam Ali
AU - Göransson, Christoffer
AU - Bertelsen, Litten
AU - Holmvang, Lene
AU - Helqvist, Steffen
AU - Pedersen, Frants
AU - Schnabel, Renate
AU - Køber, Lars
AU - Kelbæk, Henning
AU - Vejlstrup, Niels
AU - Engstrøm, Thomas
AU - Clemmensen, Peter
N1 - Publisher Copyright: © 2021 The Authors
PY - 2021/4
Y1 - 2021/4
N2 - Background: Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort. Methods: Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years. Results: Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001). Conclusion: Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.
AB - Background: Coronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort. Methods: Of 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years. Results: Younger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001). Conclusion: Having a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.
KW - Age
KW - Magnetic resonance imaging
KW - Percutaneous coronary intervention
KW - ST-segment elevation myocardial infarction
U2 - 10.1016/j.ijcha.2021.100731
DO - 10.1016/j.ijcha.2021.100731
M3 - Journal article
C2 - 33732867
AN - SCOPUS:85101805899
VL - 33
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
SN - 2352-9067
M1 - 100731
ER -
ID: 285721014