Clinical presentation and outcomes of acute myocardial infarction with vs. without ST elevation in octogenarians
Wojciech Picheta1, Bartłomiej Góra2, Mateusz Kachel2,3
1Provincial Hospital in Myszkow, Poland.
Insights
Elderly patients over 80 with ST-elevation myocardial infarction (STEMI) had higher in-hospital mortality, while non-ST-elevation myocardial infarction (NSTEMI) patients faced greater post-hospital mortality. These myocardial infarction types require distinct treatment strategies in octogenarians.
Area of Science:
- Cardiology
- Geriatric Medicine
- Acute Coronary Syndromes
Background:
- Increasing life expectancy leads to more elderly patients (octo- and nonagenarians) experiencing myocardial infarction.
- This demographic is often underrepresented in clinical trials, necessitating specific research.
- Understanding differences in presentation and outcomes for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in this age group is crucial.
Purpose of the Study:
- To compare the clinical presentation, treatment strategies, and outcomes of STEMI versus NSTEMI in patients aged 80 years and older.
- To identify specific differences in mortality rates and lesion locations between STEMI and NSTEMI in the elderly population.
Main Methods:
- A retrospective analysis of 14,758 patients over 80 hospitalized with STEMI or NSTEMI.
- Propensity score matching was used to create two equal-sized groups for comparison.
- Data were sourced from the Polish Registry of Acute Coronary Syndromes.
Main Results:
- STEMI patients were more likely to undergo coronary angiography and revascularization.
- Culprit lesion locations differed, with STEMI more commonly involving the LAD or RCA, and NSTEMI more often in the left main or other native arteries.
- Elderly patients with STEMI had higher 30-day and 1-year all-cause mortality, primarily driven by in-hospital mortality. NSTEMI survivors experienced higher 1-year post-hospital mortality.
Conclusions:
- STEMI and NSTEMI present differently and require distinct management approaches in patients over 80.
- STEMI is associated with higher immediate in-hospital mortality.
- NSTEMI is linked to increased mortality risk in the year following hospital discharge.
Background:
As a result of increased life expectancy, the number of octa- and nonagenarians presenting with myocardial infarction is on the rise. These patients are often underrepresented in clinical trials. The aim of this study was to compare the presentation and outcomes of ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in patients older than 80 years.
Methods:
This retrospective study included 14758 patients above 80 years of age hospitalized with STEMI or NSTEMI who were selected from the Polish Registry of Acute Coronary Syndromes using propensity score matching (two equal size groups).
Results:
Patients with STEMI were more likely to undergo coronary angiography (87.80% vs. 77,03%) and revascularization (80.50% vs. 54.26%); in STEMI the culprit lesion was more likely to be located in left anterior descending artery (LAD) (31.76% vs. 44.43%) or right coronary artery (RCA) (18.41% vs. 35.29%), and NSTEMI more likely to be located in left main (4.59% vs. 1.76%) or other native artery (23.3% vs. 6.02%). Elderly patients with STEMI had higher all-cause mortality at 30-days (19.62% vs. 14.51%) and 1-year (32.00% vs. 29.54%). The difference was highly influenced by initial in-hospital mortality (17.96% vs. 12.48%). Among hospital survivors there was no difference in 30-days mortality and 1-year mortality was higher for NSTEMI hospital survivors (17.06% vs. 14.04%).
Conclusions:
In patients older than 80 years of age with similar baseline characteristics, STEMI and NSTEMI had different presentation, outcomes and required different treatment strategy. ST-elevation patients had higher in-hospital mortality and NSTEMI patients had higher post-hospital mortality after 1 year.
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