Age-Related Increase in Mortality among Patients with First Myocardial Infarctions Treated with Thrombolysis
Aldo A. Maggioni, Attilio Maseri, Claudio Fresco, Maria G. Franzosi, Francesco Mauri, Eugenio Santoro, Gianni Tognoni, for The Investigators of the Gruppo Italiano por lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2)
Background The overall rate of mortality due to ischemic heartdisease is known to increase progressively with age. We evaluatedthe relation between the mortality rate and age in patientswith first myocardial infarctions treated with thrombolytictherapy.
Methods We studied 9720 patients with first infarctions whohad been enrolled in the GISSI-2 trial. (This trial comparedthe efficacy of tissue plasminogen activator with that of streptokinasein patients with myocardial infarction.) Of these, only 35 percenthad a history of angina. The relation between age and mortalityduring hospitalization and during the six months after dischargewas determined by unadjusted and adjusted analyses.
Results The in-hospital mortality rate was 1.9 percent amongpatients 40 years old or younger, but it increased to 31.9 percentamong those more than 80 years old; however, values for indicatorsof infarct size did not increase with age. Autopsies were performedin 20 percent of the 772 patients who died in the hospital;the findings showed that the frequency of cardiac rupture increasedfrom 19 percent among patients 60 years old or younger to 86percent among those more than 70 years old. The mortality ratefor the first six months after hospital discharge also increasedsignificantly with age. After adjustment for confounding variables,older age continued to be significantly associated with a higherrisk of in-hospital and post-discharge death. When age was introducedinto a multivariate model as a continuous variable, the riskof death was estimated to increase by about 6 percent per yearfor both in-hospital and six-month mortality rates.
Conclusions In patients with first myocardial infarctions whoreceived thrombolytic therapy, age was a powerful independentpredictor of both in-hospital and post-discharge mortality rates.The exponential, age-related increase in the mortality ratedid not appear to be explained by larger infarcts.
Source Information
A complete list of the investigators and centers participating in GISSI-2 has been published (Lancet 1990;336:65-71). The steering committee consisted of G.A. Feruglio, A. Lotto, F. Rovelli, P. Solinas, L. Tavazzi, and G. Tognoni. These studies were endorsed by the Associazione Nazionale Medici Cardiologi Ospedalieri and the Istituto di Ricerche Farmacologiche Mario Negri.
Address reprint requests to Dr. Maggioni at the GISSI-2 Coordinating Center, Via Eritrea 62, 20157 Milan, Italy.
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