Factors related to the use of reperfusion strategies in elderly patients with acute myocardial infarction

OBJECTIVE To examine the use of reperfusion strategies in elderly patients with acute myocardial infarction (AMI) and investigate the factors affecting its use. METHODS This survey population consisted of 338 consecutive elderly patients with AMI (> or = 65 years) who were admitted to the department of cardiology of Beijing Military General Hospital between December 2003 and November 2007. The patients were divided into two groups based on the receiving of reperfusion strategies: a reperfusion group (n = 252) and a non-reperfusion therapeutic group(n = 86). Qualitative data were compared between the two groups using Chi-square tests and multiple binary logistic regression was used to determine the relationship between various patient-related factors with the probability of choosing reperfusion therapies or not. RESULTS About 74.6% of the elderly patients with AMI received reperfusion strategies [62.2% percutaneous coronary intervention (PCI) and 12.4% thrombolysis]. Stepwise logistic regression analysis revealed that age > or = 75 years (OR = 0.255, P = 0.000), history of angina(OR = 0.570, P = 0.016) and high Killip classification (OR = 0.671, P = 0.012) were confirmed factors for receiving less reperfusion therapy. Meanwhile, inferior wall myocardial infarction (MI) with complicating right ventricular MI(OR = 4.585, P = 0.002), sweating (OR = 1.970, P = 0.016), unbearable symptoms (OR = 1.836, P = 0.038) and medical insurance (OR = 1.968, P = 0.029) were independent predictors for receiving reperfusion therapy. Intracranial hemorrhage (2.8% vs 7.1%, P = 0.000), left ventricular ejection time < 45% (12% vs 31%, P = 0.016) and mortality rate within 1 year (2.3% vs 4.7%, P = 0.039) were obviously decreased in the PCI group as compared with the thrombolysis group. CONCLUSIONS Aging, medical history of angina, high Killip classification, inferior MI with complicating right ventricular MI, sweating, unbearable symptoms and medical insurance were independent predictors for receiving reperfusion strategies.