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Primary Coronary Intervention in Octogenarians and Nonagenarians With ST-Segment Elevation Myocardial Infarction: A
Rajat Sharma1, Brett Hiebert1, David Cheung1
11 Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Very elderly patients (>80) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) experienced worse outcomes. Despite similar mortality, their overall survival was reduced compared to younger controls.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- The population of individuals over 80 years old is growing and represents an increasing proportion of ST-segment elevation myocardial infarction (STEMI) cases.
- Very elderly patients often have complex health profiles, necessitating specific outcome evaluations.
Purpose of the Study:
- To assess in-hospital outcomes and one-year survival rates for patients over 80 years old who present with STEMI and undergo primary percutaneous coronary intervention (pPCI).
- To compare the outcomes of very elderly STEMI patients undergoing pPCI with a younger control group.
Main Methods:
- A retrospective study conducted between 2009 and 2015 at a Canadian tertiary care center.
- Inclusion of 164 octogenarians and 20 nonagenarians (very elderly group) with STEMI undergoing pPCI.
- Comparison with a randomly selected control group of 100 individuals aged 65 to 69 years.
Main Results:
- The very elderly population (>80 years) constituted 11.1% of all pPCIs performed during the study period.
- Compared to controls, very elderly patients experienced treatment delays, higher rates of bleeding, acute kidney injury, and rehospitalization.
- A trend towards longer hospital stays was observed in the very elderly group post-pPCI.
Conclusions:
- In-hospital and one-year mortality rates were comparable between very elderly STEMI patients and controls.
- Despite similar mortality, very elderly patients demonstrated reduced overall survival following pPCI for STEMI compared to the younger control cohort.
- These findings highlight the need for tailored management strategies for very elderly patients with STEMI undergoing pPCI.
Abstract:
The proportion of individuals >80 years of age constitute an increasing proportion of patients who present with ST-segment elevation myocardial infarction (STEMI). The objective of this study is to evaluate in-hospital outcomes and 1-year survival of very elderly patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI). Between 2009 and 2015, individuals >80 years of age (very elderly patients) with an STEMI presenting at a single tertiary Canadian care center were included in the study. A random sample of 100 individuals aged 65 to 69 years over the same time period were selected as a control group. A total of 284 patients were included in the study population including 100 controls, 164 octogenarians, and 20 nonagenarians. Of total, 1661 pPCIs occurred during this study period with the very elderly population (>80 years) comprising 11.1% of the total pPCIs. Compared with controls, individuals aged >80 are more likely to have a delay in treatment with increased rates of bleeding, acute kidney injury, rehospitalization, and a trend toward longer hospital stays following pPCI for STEMI. Although in-hospital and 1-year mortality were similar between both cohorts >80 years of age with STEMI, their overall survival was reduced compared with controls.
