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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

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@article{c217c4b63b8741949398593cbdc2bb56,
title = "Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction – A cardiac magnetic resonance imaging study",
abstract = "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.",
keywords = "Age, Magnetic resonance imaging, Percutaneous coronary intervention, ST-segment elevation myocardial infarction",
author = "{Gabriel Topal}, Divan and {Aleksov Ahtarovski}, Kiril and Jacob L{\o}nborg and Dan H{\o}fsten and Lars Nepper-Christensen and Kasper Kyhl and Mikkel Schoos and Ghotbi, {Adam Ali} and Christoffer G{\"o}ransson and Litten Bertelsen and Lene Holmvang and Steffen Helqvist and Frants Pedersen and Renate Schnabel and Lars K{\o}ber and Henning Kelb{\ae}k and Niels Vejlstrup and Thomas Engstr{\o}m and Peter Clemmensen",
note = "Funding Information: The Danish Agency for Science, Technology and Innovation, Rigshospitalet Research Pool, the Danish Council for Strategic Research (Eastern Denmark Initiative to Improve Revascularization Strategies [EDITORS], grant 09-066994). Publisher Copyright: {\textcopyright} 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = apr,
doi = "10.1016/j.ijcha.2021.100731",
language = "English",
volume = "33",
journal = "IJC Heart and Vasculature",
issn = "2352-9067",
publisher = "Elsevier BV",

}

RIS

TY - JOUR

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 - Funding Information: The Danish Agency for Science, Technology and Innovation, Rigshospitalet Research Pool, the Danish Council for Strategic Research (Eastern Denmark Initiative to Improve Revascularization Strategies [EDITORS], grant 09-066994). Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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

UR - http://www.scopus.com/inward/record.url?scp=85101805899&partnerID=8YFLogxK

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: 67233953