ST-segment elevation myocardial infarction in older adults: echocardiographic characterization and outcomes in
Laima Caunite1, Rinchyenkhand Myagmardorj2, Xavier Galloo2,3
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands. l.caunite@lumc.nl.
Insights
Older patients (≥80 years) with ST-elevation myocardial infarction (STEMI) experienced worse cardiac remodeling but similar left ventricular (LV) function recovery compared to younger patients. Despite different medication use, outcomes highlight disparities in care for elderly STEMI survivors.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Limited evidence exists regarding cardiac remodeling, left ventricular (LV) function, medication use, and outcomes in elderly patients (≥80 years) following ST-elevation myocardial infarction (STEMI).
- Understanding these aspects is crucial for optimizing care and improving prognosis in this vulnerable population.
Purpose of the Study:
- To examine cardiac remodeling, LV function recovery, medication patterns, and clinical outcomes one year post-STEMI in patients aged ≥80 years compared to younger patients (<80 years).
- To analyze long-term (five-year) all-cause mortality differences between these age groups.
Main Methods:
- Retrospective analysis of STEMI registry data from 2178 patients, with a subgroup of 132 patients aged ≥80 years.
- Echocardiography performed at baseline and one year post-STEMI to assess LV remodeling (defined as >20% relative increase in LV end-diastolic volume) and LV ejection fraction.
- Comparison of one-year cardiovascular outcomes, medication use (beta-blockers, renin-angiotensin-aldosterone system inhibitors, diuretics), and five-year all-cause mortality between older and younger patient groups.
Main Results:
- Older patients exhibited worse baseline LV ejection fraction (47.2% vs. 49.8%) and higher rates of adverse LV remodeling (29% vs. 19%).
- Despite these differences, LV function improved similarly in both age groups over one year.
- Older patients received lower rates of beta-blockers and renin-angiotensin-aldosterone system inhibitors but higher rates of diuretics at discharge and one year, correlating with increased heart failure hospitalization rates (7.0% vs. 2.6%) and significantly higher five-year mortality (25.8% vs. 4.3%).
Conclusions:
- Elderly STEMI patients experience more adverse LV remodeling but achieve comparable LV function recovery to younger counterparts.
- Disparities in guideline-directed medical therapy, particularly lower use of beta-blockers and renin-angiotensin-aldosterone system inhibitors, were observed in older patients, alongside increased diuretic use.
- These factors contribute to poorer outcomes, including higher heart failure rates and significantly increased long-term mortality in the elderly STEMI population, underscoring the need for tailored management strategies.
Abstract:
Evidence on cardiac remodeling, left ventricular (LV) function recovery, medication use and outcomes in older ST-segment elevation myocardial infarction (STEMI) patients is limited. We examined these aspects at baseline and evolution one year post-infarct in patients aged ≥ 80 versus < 80.STEMI registry data were retrospectively analyzed. The older subgroup included patients aged ≥ 80 years at index hospitalization. Echocardiography was performed at baseline and one year after STEMI. LV remodeling was defined as > 20% relative increase in the LV end-diastolic volume. One-year cardiovascular outcomes and five-year all-cause mortality are reported.Study included 2178 patients; 132 (6.1%) were aged ≥ 80. Older patients had worse baseline LV ejection fraction (47.2 ± 9.6% versus 49.8 ± 8.2%; p < 0.001) and experienced more adverse LV remodeling (29% versus 19%; p = 0.024). Nevertheless, LV function improved similarly in both groups. Beta-blocker and renin-angiotensin-aldosterone system inhibitor use was lower (86.4% versus 94.2%; p < 0.001 and 90.2% versus 96.5%; p < 0.001, respectively) but diuretic prescription higher (18.2% versus 8.1%; p < 0.001) in older patients. One year post-infarct beta-blocker and renin-angiotensin-aldosterone system inhibitor use decreased and was similar in both groups, but older patients continued to receive more diuretics and suffered higher heart failure hospitalization rates (7.0% versus 2.6%; p = 0.006). Five-year mortality was 25.8% in older versus 4.3% in younger patients (log-rank χ2 133.2; p < 0.001).Older patients experienced more adverse LV remodeling, received less beta-blockers and renin-angiotensin-aldosterone system inhibitors but more diuretics at discharge and one year, compared to younger patients. Nevertheless, LV function recovered similarly in both groups.
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