Outcome of 1051 octogenarians after primary percutaneous coronary intervention for ST elevation myocardial infarction: observational cohort from the London Heart Attack Group

Abstract

Purpose: Octogenarians with STEMI are less commonly treated by primary PCI than other age groups. We present long-term survival data of a large cohort of elderly patients following primary PCI in London. Methods: This was an observational study of 10,249 patients undergoing primary PCI for STEMI at 8 London heart attack centres between January 2005 and November 2011. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (IQR range: 1.2-4.6 years). Results: A total of 1051 octogenarians (10.3%) with an average age of 84.2 years (IQR 80-101) were treated with primary PCI. Over time, the annual proportion of octogenarians increased from 9.1% in 2005 to 10.5% in 2010. Compared to patients <80, they included a higher proportion of women, and more hypertension, hypercholesterolaemia, multi-vessel disease, previous infarction and previous CABG. They were less likely to undergo radial access, receive GPIIb/IIIa inhibitors or DES. When compared with younger patients, primary PCI in octogenarians was less likely to achieve TIMI flow grade 3 (84.7% vs 88.3%, p=0.003). However, between 2005 and 2011 the rates of post-procedural TIMI flow grade 3 increased significantly from 80.5% in 2005 to 90% in 2011 (p for trend 0.05). The cumulative incidence of all-cause mortality during follow-up was significantly higher in the octogenarian group (51.6% vs 12.8%, p<0.0001). As expected, the hazard of death during follow-up increased with age (unadjusted HR 1.069 per year increase [95% CI 1.064-1.074], p<0.0001), which persisted after adjustment for other predictors of mortality (HR of 1.059 [95% CI 1.048-1.071], p<0.0001). ![Figure][1] Figure 1 Conclusion: London's experience suggests that primary PCI is increasing in this group and that despite the high long term mortality, acute survival rates are encouraging. [1]: pending:yes