STEMI IN THE ELDERLY: CONTEMPORARY OUTCOMES IN THE ERA OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Abstract

BackgroundEstablished literature confirms the high-risk nature of the elderly presenting with acute myocardial infarction (MI). However regional programs for the primary percutaneous intervention (PPCI) in ST-elevation myocardial infarction (STEMI) aim to standardize treatment and improve access to timely revascularization in all comers. Despite this, important differences in outcome among the elderly may yet exist in contemporary practice. We sought to compare clinical characteristics, method of presentation, treatment timelines, procedural and in-hospital outcomes by age and gender in patients referred to a large regional STEMI program.MethodsClinical and angiographic data were collected on all consecutive patients presenting to the Hamilton Health Sciences Regional STEMI program between April 1, 2010-March 31, 2013, via the SMART-AMI initiative. Elderly patients were defined as age>75. Baseline clinical variables were collected to calculate risk via TIMI STEMI and GRACE scores. Manner of presentation, performance variables, route of vascular access, procedural outcomes, in-hospital and 90-day mortality were analyzed.ResultsConclusionDespite implementation of a standardized regional program of STEMI care in a high volume tertiary care setting, important differences in outcomes between elderly and younger patients still exist. While the elderly are more likely to present via EMS, their higher baseline risk, delays to presentation, lower rates of radial access, greater non-reperfusion and post-procedural complications may explain some of the of excess mortality in this group. However, few or none of these may be easily modifiable. BackgroundEstablished literature confirms the high-risk nature of the elderly presenting with acute myocardial infarction (MI). However regional programs for the primary percutaneous intervention (PPCI) in ST-elevation myocardial infarction (STEMI) aim to standardize treatment and improve access to timely revascularization in all comers. Despite this, important differences in outcome among the elderly may yet exist in contemporary practice. We sought to compare clinical characteristics, method of presentation, treatment timelines, procedural and in-hospital outcomes by age and gender in patients referred to a large regional STEMI program. Established literature confirms the high-risk nature of the elderly presenting with acute myocardial infarction (MI). However regional programs for the primary percutaneous intervention (PPCI) in ST-elevation myocardial infarction (STEMI) aim to standardize treatment and improve access to timely revascularization in all comers. Despite this, important differences in outcome among the elderly may yet exist in contemporary practice. We sought to compare clinical characteristics, method of presentation, treatment timelines, procedural and in-hospital outcomes by age and gender in patients referred to a large regional STEMI program. MethodsClinical and angiographic data were collected on all consecutive patients presenting to the Hamilton Health Sciences Regional STEMI program between April 1, 2010-March 31, 2013, via the SMART-AMI initiative. Elderly patients were defined as age>75. Baseline clinical variables were collected to calculate risk via TIMI STEMI and GRACE scores. Manner of presentation, performance variables, route of vascular access, procedural outcomes, in-hospital and 90-day mortality were analyzed. Clinical and angiographic data were collected on all consecutive patients presenting to the Hamilton Health Sciences Regional STEMI program between April 1, 2010-March 31, 2013, via the SMART-AMI initiative. Elderly patients were defined as age>75. Baseline clinical variables were collected to calculate risk via TIMI STEMI and GRACE scores. Manner of presentation, performance variables, route of vascular access, procedural outcomes, in-hospital and 90-day mortality were analyzed. Results ConclusionDespite implementation of a standardized regional program of STEMI care in a high volume tertiary care setting, important differences in outcomes between elderly and younger patients still exist. While the elderly are more likely to present via EMS, their higher baseline risk, delays to presentation, lower rates of radial access, greater non-reperfusion and post-procedural complications may explain some of the of excess mortality in this group. However, few or none of these may be easily modifiable. Despite implementation of a standardized regional program of STEMI care in a high volume tertiary care setting, important differences in outcomes between elderly and younger patients still exist. While the elderly are more likely to present via EMS, their higher baseline risk, delays to presentation, lower rates of radial access, greater non-reperfusion and post-procedural complications may explain some of the of excess mortality in this group. However, few or none of these may be easily modifiable.