Key result
Elevated sPAP linked to ~108% higher five-year mortality in AMI patients aged 80 and older.
Why the study?
The prognostic impact of elevated systolic pulmonary artery pressure (sPAP) on mortality after acute myocardial infarction in elderly patients was not well studied.
Does elevated systolic pulmonary artery pressure (sPAP ≥40 mmHg) predict increased one- and five-year all-cause mortality in elderly patients (≥80 years) with 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 elderly patients (≥80 years) with acute myocardial infarction?
Elevated systolic pulmonary artery pressure (≥40 mmHg) is a strong, independent predictor of short- and long-term all-cause mortality in elderly patients following acute myocardial infarction, outperforming LVEF as a prognostic marker.
Answers are grounded in this paper and cite their sources.
Elevated sPAP may stratify short- and long-term mortality risk in elderly AMI patients; leaves open whether it should guide management.
Background: Reduced left ventricular ejection fraction (LVEF) is associated with increased mortality after myocardial infarction (MI). However, the prognostic impact of elevated systolic pulmonary artery pressure (sPAP) in the elderly patients with MI is not well studied. Purpose: We aimed to study the impact of elevated sPAP on one- and five-year all-cause mortality after acute MI in patients 80 years of age and older. Methods: Of a total number of 353 patients(≥80 years old)that were hospitalized with acute coronary syndrome, 162 patients presenting with acute MI 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. Results: Altogether 65 of 162 patients (40%) 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 65 patients (40%) 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 was an independent predictor of increased mortality in both one and five years after acute MI; HR of 3.4(95%, CI 1.4-8.2, P 0.006) and HR of 2.0(95%, CI 1.2-3.4, P 0.004) respectively, whereas LVEF did not show any statistically significant impact, neither on one- nor on five-year mortality (HR 1.4, 95% CI 0.8-2.4, p=0.158) and (HR 1.3, 95% CI 0.6-2.9, p=0.469), respectively. Conclusion: Elevated sPAP is an independent risk factor for one- and five-year all-cause mortality in patients with acute MI and it seems to be a better prognostic factor for death than LVEF. The risk of all-cause mortality in MI patients increased with increasing sPAP.
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Barywani et al. (2021) conducted a cohort in Acute Myocardial Infarction (n=162). Elevated systolic pulmonary artery pressure (sPAP ≥ 40 mmHg) vs. sPAP < 40 mmHg was evaluated on 5-year all-cause mortality (HR 2.08, 95% CI 1.25-3.44, p=0.005). Elevated systolic pulmonary artery pressure (≥40 mmHg) independently predicted a significantly increased risk of five-year all-cause mortality (HR 2.08) in patients aged 80 years and older with acute myocardial infarction.
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