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Updated: Feb 8, 2026
Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Long-Term Mortality of Older Patients With Acute Myocardial Infarction Treated in US Clinical Practice
Ajar Kochar1, Anita Y Chen2, Puza P Sharma3
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC ajar.kochar@duke.edu.
Insights
Long-term survival after myocardial infarction (MI) remains poor for older adults, with high mortality rates even after revascularization or surviving the first year. This highlights a critical need for improved post-MI care strategies in elderly populations.
Area of Science:
- Cardiovascular Medicine
- Geriatric Cardiology
- Public Health & Epidemiology
Background:
- Limited data exists on the long-term prognosis for elderly patients following myocardial infarction (MI).
- Understanding long-term outcomes is crucial for optimizing care in this vulnerable demographic.
Purpose of the Study:
- To evaluate the 8-year mortality rates in older patients (≥65 years) after myocardial infarction.
- To assess the impact of revascularization and early survival on long-term mortality.
- To compare mortality risks between ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI) in this age group.
Main Methods:
- Utilized the CRUSADE registry (2001-2006) data linked with Medicare records for patients aged ≥65 years.
- Employed Kaplan-Meier curves for unadjusted survival analysis and Cox regression for adjusted mortality risk.
- Conducted a landmark analysis, conditioning on survival through the first year post-MI.
Main Results:
- High rates of evidence-based medications (aspirin, beta-blockers, statins) were observed at discharge.
- Despite optimal medical therapy, 8-year mortality was high at 65%, with 1-year mortality at 24%.
- Mortality remained substantial even for revascularized patients (PCI 49%, CABG 46%) and those surviving the first year (59%).
- Median survival was 4.8 years, significantly lower for patients aged ≥75 years (3.1 years) compared to 65-74 years (8.2 years).
Conclusions:
- Long-term mortality following myocardial infarction remains unacceptably high in older adults in routine practice.
- Revascularization and surviving the initial post-MI year do not fully mitigate long-term mortality risks.
- Further research and interventions are needed to improve long-term outcomes for elderly MI survivors.
Background:
There is limited information about the long-term survival of older patients after myocardial infarction (MI).
Methods And Results:
CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines) was a registry of MI patients treated at 568 US hospitals from 2001 to 2006. We linked MI patients aged ≥65 years in CRUSADE to their Medicare data to ascertain long-term mortality (defined as 8 years post index event). Long-term unadjusted Kaplan-Meier mortality curves were examined among patients stratified by revascularization status. A landmark analysis conditioned on surviving the first year post-MI was conducted. We used multivariable Cox regression to compare mortality risks between ST-segment-elevation myocardial infarction and non-ST-segment-elevation myocardial infarction patients. Among 22 295 MI patients ≥ age 65 years (median age 77 years), we observed high rates of evidence-based medication use at discharge: aspirin 95%, β-blockers 94%, and statins 81%. Despite this, mortality rates were high: 24% at 1 year, 51% at 5 years, and 65% at 8 years. Eight-year mortality remained high among patients who underwent percutaneous coronary intervention (49%), coronary artery bypass graft (46%), and among patients who survived the first year post-MI (59%). Median survival was 4.8 years (25th, 75th percentiles 1.1, 8.5); among patients aged 65-74 years it was 8.2 years (3.3, 8.9) while for patients aged ≥75 years it was 3.1 years (0.6, 7.6). Eight-year mortality was lower among ST-segment-elevation myocardial infarction than non-ST-segment-elevation myocardial infarction patients (53% versus 67%); this difference was not significant after adjustment (hazard ratio 0.94, 95% confidence interval, 0.88-1.00).
Conclusions:
Long-term mortality remains high among patients with MI in routine clinical practice, even among revascularized patients and those who survived the first year.
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