Key result
Elevated sPAP is linked to ~163% higher one-year mortality post-AMI in patients 80 and older.
Why the study?
Data regarding the prognostic impact of elevated systolic pulmonary artery pressure (sPAP) after acute myocardial infarction in very elderly patients were lacking.
Does elevated systolic pulmonary artery pressure (sPAP ≥ 40 mmHg) predict increased one- and five-year all-cause mortality in very elderly patients (≥ 80 years) after acute myocardial infarction?
Cohort (n=162)
Yes
Does elevated systolic pulmonary artery pressure (sPAP ≥ 40 mmHg) predict increased one- and five-year all-cause mortality in very elderly patients (≥ 80 years) after acute myocardial infarction?
Elevated sPAP may refine mortality risk stratification in octogenarians post-AMI; leaves open whether it should guide interventions.
Reduced left ventricular ejection fraction (LVEF) is associated with increased mortality after acute myocardial infarction (AMI). However, the prognostic impact of elevated systolic pulmonary artery pressure (sPAP) in the very elderly patients after AMI is lacking. We aimed to study the impact of elevated sPAP on one- and five-year all-cause mortality after AMI in very elderly patients, 80 years of age and older. Of a total number of 353 patients (≥ 80 years) who were hospitalized with acute coronary syndrome, 162 patients presenting with AMI and with available data of sPAP on echocardiography were included and followed-up for 5 years. The survival analyses were performed using Cox-Regression models adjusted for conventional risk factors including LVEF. Altogether 66 of 162 patients (41%) had ST-segment elevation MI, and 121 (75%) of patients were treated with percutaneous coronary intervention in the acute phase. Echocardiography during the admission revealed that 78 patients (48%) had a LVEF ≤ 45% and 66 patients (41%) had a sPAP ≥ 40 mmHg. After one and five years of follow-up, 23% (n = 33) and 53% (n = 86) of patients died, respectively. A multivariable Cox-Regression analysis showed that the elevated sPAP (≥ 40 mmHg) was an independent predictor of increased mortality in both one and five years after AMI; HR of 2.63 (95%, CI 1.19-5.84, P 0.017) and HR of 2.08 (95%, CI 1.25-3.44, P 0.005) respectively, whereas LVEF ≤ 45% did not show any statistically significant impact, neither on one- nor on five-year mortality (HR 1.3, 95% CI 0.6-2.9, p = 0.469) and (HR 1.4, 95% CI 0.8-2.4, p = 0.158), respectively. Elevated sPAP was an independent risk factor for one- and five-year all-cause mortality after AMI in very elderly patients and sPAP seems to be a better prognostic predictor for all-cause mortality than LVEF. The risk of all-cause mortality after AMI increased with increasing sPAP.
No takes yet. Share an insight, caveat, or question.
Barywani et al. (2022) conducted a cohort in Acute myocardial infarction (n=162). Elevated systolic pulmonary artery pressure (≥ 40 mmHg) vs. Systolic pulmonary artery pressure < 40 mmHg was evaluated on 1-year all-cause mortality (HR 2.63, 95% CI 1.19-5.84, p=0.017). Elevated systolic pulmonary artery pressure (≥40 mmHg) increased one-year (HR 2.63) and five-year (HR 2.08) all-cause mortality after acute myocardial infarction in patients aged 80 years and older.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: