0112: Major improvement in one-year mortality in elderly patients with acute myocardial infarction in relation with early PCI and recommended medications. The FAST-MI programme

Abstract

Outcomes of AMI patients have substantially improved over the past 2 decades. Whether similar trends are observed in elderly (≥75 years of age) and younger patients has not been extensively studied. We analysed one-year mortality of elderly vs younger patients in 4 nationwide French survey carried out 5 years apart from 1995 to 2010. Consecutive STEMI and NSTEMI patients (≤48 hours from onset) were recruited over one-month periods. Among 10610 patients included in the 4 surveys, 3389 (32%) were aged 75+. From 1995 to 2010, the proportion of 75+ remained stable in NSTEMI (1995: 36%, 2010: 38%), but decreased in STEMI patients (1995: 30%, 2010: 25.5%, P=0.006). Use of PCI ≤72 hours of admission increased from 6.0% to 54.9% in tin the past 15 years he 75+, and from 19% to 77% in the younger pts, use of new anticoagulants increased from 0 to 62% and 0 to 79%, respectively, and use of recommended secondary prevention medications from 2% to 43% and from 9% to 69% respectively. All clinical outcomes improved both in the 75+ and <75 age groups (Table). Risk of one-year death in 2010 vs 1995 was HR 0.48 (0.40-0.59) in the 75+ and HR 0.38 (0.29-0.50) in younger patients. When early use of PCI, recommended medications and new anticoagulants were added to the models, survey period was no longer significantly associated with one-year death. In these 4 nationwide surveys of AMI pts conducted over a 15-year period, outcomes improved markedly in elderly as in younger patients. Most of the improvement in outcomes appear mediated by improved early management (use of PCI and medications). Abstract 0112 – Table: Evolution of outcomes from 1995 to 2010 across age groups <75 years (n=7.221) 1995-2000-2005-2010 ≥75 years (n=3.389) 1995-2000-2005-2010 VF 4.0 – 2.3 – 1.5 – 1.2% 4.6 – 4.9 – 2.0 – 1.0% AF 7.7 – 5.0 – 3.7 – 2.9% 21.5 – 16.8 – 9.5 – 10.1% Reinfarction NA – 2.3 – 1.5 – 0.8% NA – 2.9 – 2.4 – 1.8% Stroke NA – 0.7 – 0.7 – 0.4% NA – 1.6 – 1.4 – 0.5% Shock 4.7 – 4.4 – 4.0 – 2.7% 11.6 – 13.6 – 9.3 – 6.7% 30-day death 7.2 – 4.8 – 2.9 – 1.4% 25.0 – 16.8 – 13.0 – 8.4% One-year death 10.9 – 8.8 – 5.9 – 3.9% 36.2 – 30.0 – 26.9 – 20 0%