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Clinical Research in Cardiology

, Volume 102, Issue 11, pp 837–845 | Cite as

Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry

  • Els H. VandecasteeleEmail author
  • Marc De Buyzere
  • Sofie Gevaert
  • Antoine de Meester
  • Carl Convens
  • Philippe Dubois
  • Jean Boland
  • Peter Sinnaeve
  • Herbert De Raedt
  • Pascal Vranckx
  • Patrick Coussement
  • Patrick Evrard
  • Christophe Beauloye
  • Marc Renard
  • Marc J. Claeys
Original Paper

Abstract

Background

Treatment strategies and outcome of ST-elevation myocardial infarction (STEMI) have been mainly studied in middle-aged patients. With increasing lifetime expectancy, the proportion of octogenarians will substantially increase. We aimed to evaluate whether the benefit of currently recommended reperfusion strategies is maintained in octogenarians.

Methods

Reperfusion therapy and in-hospital mortality were evaluated in 1,092 octogenarians and compared with 7,984 STEMI patients <80 years old based on data from the prospective Belgian STEMI registry.

Results

The octogenarian STEMI group had more cardiovascular comorbidities, contained more female patients and presented more frequently with cardiac failure (Killip class >1, 40 vs. 20 %) compared with their younger counterparts (all p < 0.05). Although the rate of thrombolysis was similar (9.2 vs. 9.9 %) between both groups, a conservative approach was chosen more frequently (13.8 vs. 4.7 %), while PCI was performed less frequently (76.9 vs. 85.4 %) in octogenarians (p < 0.001). Moreover, ischemic time and door-to-needle/balloon time were longer for octogenarians. In-hospital mortality for octogenarians was 17.8 vs. 5.5 % in the younger group [adjusted OR 2.43(1.92–3.08)]. In haemodynamically stable octogenarians, PCI seemed to improve outcome compared with thrombolysis or conservative treatment (5.7 vs. 12.7 vs. 8.5 %, p = 0.09). In octogenarians with cardiac failure, in-hospital mortality was extremely high independent of the chosen reperfusion therapy (34.6 vs. 31.6 vs. 36.3 %, p = 0.88).

Conclusions

In-hospital mortality in octogenarian STEMI patients was high and related to a high prevalence of cardiac failure. Less PCI was performed in the octogenarian group compared with the younger patients, although mortality benefit of PCI was maintained in haemodynamically stable octogenarians.

Keywords

ST-elevation myocardial infarction Elderly Reperfusion 

Notes

Acknowledgments

Grant support

The national ST-segment Elevation Myocardial Infarction Database is financially supported by a grant from the Ministry of Social Affairs of the Government of Belgium.

Conflict of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Els H. Vandecasteele
    • 1
    Email author
  • Marc De Buyzere
    • 1
  • Sofie Gevaert
    • 1
  • Antoine de Meester
    • 2
  • Carl Convens
    • 3
  • Philippe Dubois
    • 4
  • Jean Boland
    • 5
  • Peter Sinnaeve
    • 6
  • Herbert De Raedt
    • 7
  • Pascal Vranckx
    • 8
  • Patrick Coussement
    • 9
  • Patrick Evrard
    • 10
  • Christophe Beauloye
    • 11
  • Marc Renard
    • 12
  • Marc J. Claeys
    • 13
  1. 1.Department of CardiologyGhent University HospitalGhentBelgium
  2. 2.Hôpital de Jolimont, Haine-Saint-PaulHainautBelgium
  3. 3.ZNAAntwerpenBelgium
  4. 4.CHUCharleroiBelgium
  5. 5.CHR Citadelle LiègeLiègeBelgium
  6. 6.UZLeuvenBelgium
  7. 7.OLV Ziekenhuis AalstAalstBelgium
  8. 8.Virga Jesse HasseltHasseltBelgium
  9. 9.AZ Sint-Jan BruggeBruggeBelgium
  10. 10.UCL Mont-GodinneYvoirBelgium
  11. 11.UCL Louvain-la-NeuveLouvain-la-NeuveBelgium
  12. 12.ULB BrusselsBrusselsBelgium
  13. 13.UZ AntwerpenAntwerpenBelgium

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