Temporal trends in the use of reperfusion therapy and outcomes in elderly patients with first ST elevation myocardial infarction.

Abstract

To analyze secular trends in management and short and long-term prognosis of elderly presenting with ST-elevation myocardial infarction (STEMI). All patients ≥ 75 years with first STEMI admitted to our Coronary Care Unit between 1988 and 2008 were included. Baseline characteristics, clinical management, in-hospital and post-discharge outcomes in 4 time periods (1988-1993, 1994-1998, 1999-2003, 2004-2008) were compared. The final cohort consisted of 1393 patients. During the study period, there was a significant increase in the use of aspirin, β-blockers and ACE inhibitors. A significant reduction in the development of cardiogenic shock and mechanical complications was noticed. The use of reperfusion therapy increased significantly, due to a wider use of primary percutaneous coronary intervention (PPCI) while 30-days, 1-year and 5-year mortality decreased throughout the 20-year study period (p<0.001). In the multivariable logistic regression model, patients treated with PPCI showed a significantly lower 30-day (OR 0.47, 95% CI, 0.31-0.71), 1-year (OR 0.62, 95% CI 0.43-0.88) and 5-year mortality (OR 0.57, 95% CI 0.41-0.79) while patients receiving fibrinolysis showed a non-significant improvement in 30-day (OR 0.86, 95% CI 0.62-1.49), 1-year (OR 0.86, 95% CI 0.58-1.30) and 5-year mortality (OR 0.82, 95% CI 0.56-1.19). The use of reperfusion therapy, and particularly of PPCI, for elderly patients suffering from STEMI increased significantly during the study period. This change in therapy was associated with a marked improvement in short and long-term prognosis.