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Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network

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Summary

Background and aim

Our senescent society includes a growing number of elderly people suffering from ST-elevation myocardial infarction (STEMI); however, exactly this population is often underrepresented in randomized trials. Hence, our aim was to investigate the influence of age on patient characteristics, as well as short- and long-term outcome in the Vienna STEMI registry.

Methods

We included all patients of the Vienna STEMI registry (2003–2009). Patients were stratified into age cohorts (≤45, 46–59, 60–79 and ≥80 years, respectively). Differences between cohorts were investigated by descriptive statistics and regression models. Crude and adjusted mortality rates were investigated using log rank test and Cox regression models, respectively. The influence of treatment on mortality was further investigated using propensity score matching.

Results

A total of 4579 patients fulfilled the criteria for further investigation. With rising age of cohorts, the number of females, diabetes mellitus (DM), hypertension (HTN), previous myocardial infarction (MI), shock, no reperfusion therapy and anterior wall infarction significantly increased. In contrast, the number of patients with a positive family history, smoking and hyperlipidemia (HLP) significantly declined. Log rank analysis showed significant differences between age cohorts for short- and long-term mortality. Cox regression analysis for short-term mortality revealed an independent association for age at the event, HTN and shock, while age, smoking, DM, HTN, HLP, previous MI and shock independently influenced long-term mortality after correction for confounders. Also, we found a significant association of age and total ischemic time (TIT), which however had no influence on long-term mortality (interaction term p = 0.236). Propensity score matching revealed reduced mortality rates for patients who received reperfusion therapy compared to conservative management, irrespective of age.

Conclusions

Increasing age independently influenced short- and long-term mortality in patients with STEMI in the Vienna STEMI network. The TIT significantly increased with baseline age, but had no impact on mortality. Furthermore, reperfusion therapy exerted beneficial effects irrespective of the patients’ age.

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Funding

This work was supported by the Association for Research on Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) and the Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna.

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Authors and Affiliations

  1. 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria

    Paul Michael Haller M.D., Bernhard Jäger M.D., Serdar Farhan M.D &  Kurt Huber M.D.

  2. 5th Medial Department, Cardiology, Sozialmedizinisches Zentrum Süd, Vienna, Austria

    Günter Christ M.D.

  3. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria

    Wolfgang Schreiber M.D.

  4. 2nd Medical Department, Cardiology, Krankenhaus Rudolfstiftung, Vienna, Austria

    Franz Weidinger M.D.

  5. 1st Medical Department, Cardiology, Sozialmedizinisches Zentrum Ost, Vienna, Austria

    Thomas Stefenelli M.D.

  6. 4th Medical Department, Cardiology, Krankenhaus Hietzing, Vienna, Austria

    Georg Delle-Karth M.D.

  7. Ambulance Services Vienna, Vienna, Austria

    Alfred Kaff M.D

  8. Department of Cardiology, Medical University of Vienna, Vienna, Austria

    Gerald Maurer M.D.

  9. Vienna STEMI Registry Group, Vienna, Austria

    Paul Michael Haller M.D., Bernhard Jäger M.D., Serdar Farhan M.D, Günter Christ M.D., Wolfgang Schreiber M.D., Franz Weidinger M.D., Thomas Stefenelli M.D., Georg Delle-Karth M.D., Alfred Kaff M.D, Gerald Maurer M.D. &  Kurt Huber M.D.

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  1. Paul Michael Haller M.D.
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  2. Bernhard Jäger M.D.
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  3. Serdar Farhan M.D
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  4. Günter Christ M.D.
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  5. Wolfgang Schreiber M.D.
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  6. Franz Weidinger M.D.
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  7. Thomas Stefenelli M.D.
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  8. Georg Delle-Karth M.D.
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  9. Alfred Kaff M.D
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  10. Gerald Maurer M.D.
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  11. Kurt Huber M.D.
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Corresponding authors

Correspondence to Paul Michael Haller M.D. or Kurt Huber M.D..

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Conflict of interest

P.M. Haller, B. Jäger, S. Farhan, G. Christ, W. Schreiber, F. Weidinger, T. Stefenelli, G. Delle-Karth, A. Kaff, G. Maurer, and K. Huber declare that they have no competing interests.

Ethical standards

The study was performed according to the 1964 Helsinki declaration and its later amendments and was approved by the local ethics committee.

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Haller, P.M., Jäger, B., Farhan, S. et al. Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network. Wien Klin Wochenschr 130, 172–181 (2018). https://doi.org/10.1007/s00508-017-1250-7

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