Abstract P211: Temporal Trends and Long-Term Outcomes of Elderly Patients With St-Elevation Myocardial Infarction in a Large Rural Healthcare System

Abstract

Background: Limited data about long-term survival in elderly patients after ST-elevation myocardial infarction (STEMI) exists for patients in rural settings. We aimed to evaluate temporal trends in lytic use compared to primary percutaneous coronary intervention (PPCI) in elderly patients after the American Heart Association’s Mission: Lifeline program was implemented. Methods: Retrospective cohort included patients aged >=75 years with STEMI presenting to 2 PCI-capable hospitals (Essentia Health in Duluth, MN and Fargo, ND) between 5/2009 to 12/2017. Cox regression was used for survival analysis and logistic regression for 30-day and 1-year mortality and 30-day readmission. Results were adjusted for age and gender. Results: A total of 358 elderly patients with true STEMI were included (51.1% female, mean age 82.2 years, 61.5% rural). The percentage of elderly patients who received lytics decreased from 20.3% in 2009-2010 to 4.8% in 2016-2017. Median first medical contact (FMC) to device time was 128 min (IQR 84-169) and median positive ECG to device time was 107 min (IQR 78-140). FMC to Device <120 min. was 44.3%; ECG to device <120 min. was 61.6%. There was no difference in survival between lytic and PPCI (HR:1.11, 95%CI:0.67-1.86, p=0.68). Mortality was not significantly different between the recent cohort (2016-2017) compared to early cohort (2009-2010) (p=0.16, HR 1.43 (0.86-2.30). Conclusion: Long-term mortality remains high among elderly patients with STEMI, even among revascularized patients. Prognosis has not significantly changed over the past 8 years despite system changes in treatment strategy.