Treatment and outcomes of nonagenarians with ST-elevation myocardial infarction
Costin N Ionescu1, Marcos Amuchastegui, Simina Ionescu
1Hospital of Saint Raphael, Division of Cardiology, 1450 Chapel Street, New Haven, CT 06511, USA. cnionescu@yahoo.com
Insights
Percutaneous coronary intervention (PCI) offers a survival benefit for nonagenarian patients with ST-elevation myocardial infarction (STEMI), particularly when administered promptly. Prompt PCI treatment should be considered for elderly STEMI patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Current ST-elevation myocardial infarction (STEMI) guidelines do not impose an age limit for reperfusion therapy.
- Despite potential benefits, reperfusion therapy is underutilized in elderly populations.
- Elderly patients (≥90 years) with acute coronary syndrome represent a vulnerable group requiring specific treatment considerations.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous coronary intervention (PCI) in nonagenarian patients (≥90 years) diagnosed with ST-elevation myocardial infarction (STEMI).
- To compare in-hospital mortality and long-term survival outcomes between PCI and medical therapy in this specific age group.
Main Methods:
- Retrospective analysis of patients aged ≥90 years with STEMI admitted between 2004 and 2008.
- Data collection included patient demographics, comorbidities, time to presentation, treatment modality (PCI vs. medical therapy), and in-hospital outcomes.
- Kaplan-Meier survival analysis was employed to compare survival curves between treatment groups.
Main Results:
- Twenty-four nonagenarian patients with STEMI were identified; most were Caucasian, female, and hypertensive.
- Only 29% presented within 6 hours of symptom onset.
- In-hospital mortality was lower in the PCI group (23%) compared to the medical therapy group (36%), with a demonstrated survival benefit favoring PCI in early presenters (<6 hours).
- PCI-treated patients experienced no procedure-associated complications and had a favorable prognosis upon hospital discharge.
Conclusions:
- Percutaneous coronary intervention (PCI) should be considered for nonagenarian patients presenting with ST-elevation myocardial infarction (STEMI).
- Prompt reperfusion therapy, specifically PCI, appears to improve survival outcomes in elderly STEMI patients who present within 6 hours.
- Nonagenarians treated with PCI can achieve good prognoses if they survive hospitalization.
Abstract:
There is no age limit for reperfusion therapy in the current guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI). Reperfusion therapy, although associated with better outcomes, is not always offered to the oldest patients. A retrospective analysis at our institution of all patients ≥ 90 years of age with a diagnosis of acute coronary syndrome at discharge from 2004 to 2008 identified 24 patients with STEMI. The majority of patients were Caucasian, females, hypertensive, with a low incidence of dementia and diabetes. Only 29% of patients presented to the hospital in less than 6 hours. Thirteen patients were treated with percutaneous coronary intervention (PCI) and 11 patients were treated medically. The in-hospital mortality was 23% in the PCI group and 36% in the medical therapy group. Kaplan-Meier analysis demonstrated a survival benefit favoring PCI, which disappeared when only patients presenting after 6 hours to the hospital were analyzed. PCI-treated patients had no procedure-associated complications and had a good prognosis if they survived to hospital discharge. PCI should be offered to nonagenarians presenting with STEMI.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Angina V: Nursing Management
01:14Myocarditis III: Medical Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:22Myocarditis IV: Nursing Management