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Activation of PPCI team in the octogenarian and nonagenarians population: real-world single-centre experience
Rajesh Kumar1, Cormac O'Connor2, Jathinder Kumar2
1Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland rajesh2k7@yahoo.com.
Insights
Elderly patients (80+) with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) show improved survival rates. PPCI significantly reduces 1-year mortality compared to conservative management in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Healthcare advancements lead to more octogenarians presenting with ST-elevation myocardial infarction (STEMI).
- Limited research exists on STEMI outcomes in patients aged 80 and above, as they are often excluded from clinical trials.
- An aging global population necessitates understanding STEMI management in the elderly.
Purpose of the Study:
- To investigate the outcomes of patients aged 80 and older presenting with STEMI.
- To identify factors associated with better or worse outcomes in this elderly STEMI population.
- To evaluate the effectiveness of early revascularization therapies in octogenarians.
Main Methods:
- A single-centre retrospective observational study.
- Inclusion criteria: patients aged 80+ presenting with STEMI between January 2014 and December 2019.
- Data collected via chart review and STEMI database analysis; Bayesian statistics used.
Main Results:
- 159 of 1301 STEMI patients (12.2%) were aged 80+; 22.1% received conservative management.
- Primary percutaneous coronary intervention (PPCI) was performed in 97/107 eligible patients.
- PPCI group had 22.4% 1-year mortality versus 48% in the conservatively managed group (p=0.005).
- Cardiogenic shock, low ejection fraction, and elevated troponin/creatinine were linked to higher mortality.
Conclusions:
- Octogenarian STEMI patients undergoing PPCI experience significantly lower 1-year mortality.
- Survival at 1 year was 77.6% for PPCI patients, with 92.4% discharged home.
- Cardiogenic shock portends a poor prognosis (87.5% 1-year mortality), but favorable outcomes are achievable without it.
Objective:
Advancement in healthcare provision has led to increasing octogenarian ST elevation myocardial infarction (STEMI) presentation to hospital for early revascularisation therapies. Limited literature to date exists to suggest octogenarian STEMI population; with majority of trials excluding these age group patients. Due to an ageing population, we expect increasing rates of STEMI in the octogenarian and nonagenarian population in the future. This study seeks to identify the outcomes of patients over the age of 80 presenting with STEMI and determine the factors associated with better or worse outcome.
Patients And Methods:
This study is a single-centre retrospective observational study involving patients' age 80 or older presenting with STEMI between January 2014 and December 2019. Patient data were collected by chart review and analysis of the local STEMI database. Standard Bayesian statistics were employed for analysis.
Results:
1301 patients presented with STEMI during this period. 159/1301 (12.2%) were 80 years or older that fulfilled STEMI criteria, 35/159 (22.1%) were medically managed. 107/124 (86.29%) had angiographic evidence of acute total or partial thrombotic occlusion, and 97/107 were treated with primary percutaneous coronary intervention (PPCI). The activation ECG most commonly exhibited an anterior STEMI, while inferior STEMI ECGs had the strongest positive predictive value. PPCI group had a 30-day mortality rate of 20% (p=0.07) and 1-year mortality was 22.4%. Highest mortality was observed with cardiogenic shock, low ejection fraction, higher high sensitivity cardiac troponin T and creatinine at presentation. Conservatively managed patients had significant higher mortality rate (48% vs 22.4%, p=0.005) at 1 year.
Conclusion:
Patients over the age of 80 who present with STEMI and undergo PPCI have a significantly lower mortality rate at 1 year. These patients have a 77.6% survival at 1 year, with 92.4% likelihood of discharge to home (without need for long-term nursing home care). Cardiogenic shock in this group was associated with a 1-year mortality of 87.5%. Despite the advanced age, we suggest favourable outcomes described in the absence of patients presenting with cardiogenic shock.
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