What is the clinical evidence from this study?

Study design: Observational. Population: Acute Myocardial Infarction (n=412). Intervention: Poor pre-admission activities of daily living (modified KATZ index) vs. Better pre-admission activities of daily living. Primary outcome: In-hospital death (OR 1.212, 95% CI 1.001-1.469, p=0.049).

September 11, 2020Open Access

Determinants of In-Hospital Death Among the Very Elderly with Acute Myocardial Infarction

MSMasaru SeguchiJichi Medical University KSKenichi SakakuraJichi Medical University TTTakunori TsukuiNewYork–Presbyterian Hospital

Key Result

Poor pre-admission activities of daily living (modified KATZ index OR 1.212), cardiac arrest, Killip class IV, and anemia were strongly associated with in-hospital death in very elderly patients with acute myocardial infarction.

Study Design

Type

Observational (n=412)

Multicenter

Structured PICO

Population

412 very elderly patients (aged ≥80 years) with acute myocardial infarction who underwent primary percutaneous coronary intervention, evaluated for determinants of in-hospital mortality.

Outcome

In-hospital deathhard clinical

Poor pre-admission activities of daily living, cardiogenic shock, and anemia are strongly associated with in-hospital death among very elderly patients with AMI undergoing PCI.

Main Result

Odds Ratio: 1.212 (95% CI 1.001–1.469)

p-value: p=0.049

Limitations

Single-center retrospective observational study design carries a risk of selection bias.
Mortality of excluded patients was greater than that of the study patients, potentially missing risk factors.
Treatment strategies and rehabilitation programs were not consistent over the long 10-year study period.
Insufficient work-up for the causes of anemia due to patient comorbidities.
Inability to evaluate the original KATZ index due to lack of information regarding bathing.

Abstract

Since the number of elderly patients suffering from acute myocardial infarction (AMI) has been increasing in developed countries, primary percutaneous coronary intervention (PCI) for the very elderly aged ≥80 years old is already common. The study aimed to examine the determinants of in-hospital death among the very elderly with AMI in current PCI era. We included 412 consecutive AMI patients aged ≥ 80 years old who received PCI to the culprit lesion; however, 42 patients (10.2%) died during the index hospitalization. Thus, univariate and multivariate logistic regression analyses were performed to identify the determinants of in-hospital death. Of note, the modified KATZ index, which is a seven-point scale ranging from 0 to 6 (0 point indicating no dependence and six points indicating full dependence), was calculated to evaluate pre-admission activity of daily living (ADL). In multivariate analysis, cardiac arrest (OR 4.642, 95% CI 1.177-18.305, P = 0.028), Killip class IV (versus Killip class I: OR 5.732, 95% CI 1.076-16.630, P = 0.001), modified KATZ index (OR 1.212, 95% CI 1.001-1.469, P = 0.049), hemoglobin levels (OR 0.803, 95% CI 0.656-0.983, P = 0.033), use of temporary pacemaker (OR 2.603, 95% CI 1.010-6.709, P = 0.048), final Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (versus TIMI ≤ 2: OR 0.240, 95% CI 0.093-0.618, P = 0.003), and mechanical circulatory support (OR 4.264, 95% CI 1.818-10.005, P = 0.001) were found to be significantly associated with in-hospital death. In conclusion, in-hospital outcomes of the very elderly with AMI were still poor in the current PCI era. Poor pre-admission ADL as well as cardiogenic shock and anemia were determined to be strongly associated with in-hospital death.

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