摘要
Objectives The purpose of this study was to investigate the hypothesis that ci rculation via collateral vessels to an infarctrelated artery (IRA) is impaired w ith aging in patients with acute myocardial infarction (AMI). Background Animal experiments have shown that advanced age blunts the development of new vessels i n response to angiogenic cytokines. Methods Of 3,573 consecutive patients with A MI, 1,934 patients who fulfilled the following criteria were enrolled in this st udy: 1) coronary angiograms were obtained within 72 h after the onset of AMI; an d 2) IRA showed complete occlusion (Thrombolysis In Myocardial Infarction <<TIMI>> flow grade 0 or 1). Collaterals to the IRA were angiographically evaluated usin g the Rentrop score. Rentrop scores 1 to 3 were defined as demonstrating significant collaterals. Results The prevalence of collaterals decreased with age, from 47.9%, 45.8%, 43.4%, to 34.0%in patients < 50 years, 50 to 59 year s, 60 to 69 years, ≥70 years, respectively (p < 0.001). Advanced age was an ind ependent factor predicting the absence of collateral circulation to the IRA. In contrast, time to catheterization, history of angina pectoris, and preinfarction angina were independent predictors for the presence of collaterals. Multivariat e analysis showed that the absence of collaterals was an independent predictor o f in-hospital mortality in elderly patients ≥70 years (odds ratio, 15.6; 95%c onfidence interval, 3.5 to 69.6), although this finding was not significant in p atients < 70 years. Conclusions Advanced age is associated with decreased angiog raphic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.
Objectives The purpose of this study was to investigate the hypothesis that ci rculation via collateral vessels to an infarctrelated artery (IRA) is impaired w ith aging in patients with acute myocardial infarction (AMI). Background Animal experiments have shown that advanced age blunts the development of new vessels i n response to angiogenic cytokines. Methods Of 3,573 consecutive patients with A MI, 1,934 patients who fulfilled the following criteria were enrolled in this st udy: 1) coronary angiograms were obtained within 72 h after the onset of AMI; an d 2) IRA showed complete occlusion (Thrombolysis In Myocardial Infarction <<TIMI>> flow grade 0 or 1). Collaterals to the IRA were angiographically evaluated usin g the Rentrop score. Rentrop scores 1 to 3 were defined as demonstrating significant collaterals. Results The prevalence of collaterals decreased with age, from 47.9%, 45.8%, 43.4%, to 34.0%in patients < 50 years, 50 to 59 year s, 60 to 69 years, ≥70 years, respectively (p < 0.001). Advanced age was an ind ependent factor predicting the absence of collateral circulation to the IRA. In contrast, time to catheterization, history of angina pectoris, and preinfarction angina were independent predictors for the presence of collaterals. Multivariat e analysis showed that the absence of collaterals was an independent predictor o f in-hospital mortality in elderly patients ≥70 years (odds ratio, 15.6; 95%c onfidence interval, 3.5 to 69.6), although this finding was not significant in p atients < 70 years. Conclusions Advanced age is associated with decreased angiog raphic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.
