Wiener klinische Wochenschrift

, Volume 130, Issue 5–6, pp 172–181 | Cite as

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

  • Paul Michael Haller
  • Bernhard Jäger
  • Serdar Farhan
  • Günter Christ
  • Wolfgang Schreiber
  • Franz Weidinger
  • Thomas Stefenelli
  • Georg Delle-Karth
  • Alfred Kaff
  • Gerald Maurer
  • Kurt Huber
original article


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.


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.


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.


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.


STEMI Age Mortality Total ischemic time 



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.

Compliance with ethical guidelines

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.


  1. 1.
    Nichols M, Townsend N. et al. European cardiovascular disease statistics 2012. Brussels, Sophia Antipolis: European Heart Network, European Society of Cardiology; 2012.Google Scholar
  2. 2.
    Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Executive summary: heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation. 2014;129(3):399–410.CrossRefPubMedGoogle Scholar
  3. 3.
    Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, Eagle KA, White K, Mehta RH, Knobel E, Collet JP, Investigators G. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149(1):67–73.CrossRefPubMedGoogle Scholar
  4. 4.
    Halon DA, Adawi S, Dobrecky-Mery I, Lewis BS. Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients. J Am Coll Cardiol. 2004;43(3):346–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Forman DE, Chen AY, Wiviott SD, Wang TY, Magid DJ, Alexander KP. Comparison of outcomes in patients aged 〈75, 75 to 84, and 〉/= 85 years with ST-elevation myocardial infarction (from the ACTION Registry-GWTG). Am J Cardiol. 2010;106(10):1382–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Fach A, Bunger S, Zabrocki R, Schmucker J, Conradi P, Garstka D, Fiehn E, Hambrecht R, Wienbergen H. Comparison of outcomes of patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention analyzed by age groups (〈75, 75 to 85, and 〉85 years); (results from the Bremen STEMI registry). Am J Cardiol. 2015;116(12):1802–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Christiansen EC, Wickstrom KK, Henry TD, Garberich RF, Rutten-Ramos SC, Larson DM, Grey EZ, Thiessen NL, Hauser RG, Newell MC. Comparison of functional recovery following percutaneous coronary intervention for ST elevation myocardial infarction in three age groups (〈70, 70 to 79, and 〉/=80 years). Am J Cardiol. 2013;112(3):330–5.CrossRefPubMedGoogle Scholar
  8. 8.
    White HD, Barbash GI, Califf RM, Simes RJ, Granger CB, Weaver WD, Kleiman NS, Aylward PE, Gore JM, Vahanian A, Lee KL, Ross AM, Topol EJ. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global utilization of streptokinase and TPA for occluded coronary arteries trial. Circulation. 1996;94(8):1826–33.CrossRefPubMedGoogle Scholar
  9. 9.
    Guagliumi G, Stone GW, Cox DA, Stuckey T, Tcheng JE, Turco M, Musumeci G, Griffin JJ, Lansky AJ, Mehran R, Grines CL, Garcia E. Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation. 2004;110(12):1598–604.CrossRefPubMedGoogle Scholar
  10. 10.
    Dodd KS, Saczynski JS, Zhao Y, Goldberg RJ, Gurwitz JH. Exclusion of older adults and women from recent trials of acute coronary syndromes. J Am Geriatr Soc. 2011;59(3):506–11.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286(6):708–13.CrossRefPubMedGoogle Scholar
  12. 12.
    Medina HM, Cannon CP, Fonarow GC, Grau-Sepulveda MV, Hernandez AF, Peacock FW, Laskey W, Peterson ED, Schwamm L, Bhatt DL, Committee GS Investigators. Reperfusion strategies and quality of care in 5339 patients age 80 years or older presenting with ST-elevation myocardial infarction: analysis from get with the guidelines-coronary artery disease. Clin Cardiol. 2012;35(10):632–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van ’t Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619.CrossRefPubMedGoogle Scholar
  14. 14.
    American College of Emergency P, Society for Cardiovascular A Interventions, O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr., Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78–e140.CrossRefGoogle Scholar
  15. 15.
    Rathod KS, Jones DA, Gallagher S, Rathod VS, Weerackody R, Jain AK, Mathur A, Mohiddin SA, Archbold RA, Wragg A, Knight CJ. Atypical risk factor profile and excellent long-term outcomes of young patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2016;5(1):23–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Nielsen CG, Laut KG, Jensen LO, Ravkilde J, Terkelsen CJ, Kristensen SD. Patient delay in patients with ST-elevation myocardial infarction: time patterns and predictors for a prolonged delay. Eur Heart J Acute Cardiovasc Care. 2016. doi: 10.1177/2048872616676570 PubMedGoogle Scholar
  17. 17.
    Jager B, Farhan S, Rohla M, Christ G, Podczeck-Schweighofer A, Schreiber W, Laggner AN, Weidinger F, Stefenelli T, Delle-Karth G, Kaff A, Maurer G, Huber K, Vienna SRG. Clinical predictors of patient related delay in the VIENNA ST-elevation myocardial infarction network and impact on long-term mortality. Eur Heart J Acute Cardiovasc Care. 2017;Apr;6(3):254–261. doi: 10.1177/2048872616633882. Epub 2016 Feb 17.CrossRefGoogle Scholar
  18. 18.
    Fokkema ML, Wieringa WG, van der Horst IC, Boersma E, Zijlstra F, de Smet BJ. Quantitative analysis of the impact of total ischemic time on myocardial perfusion and clinical outcome in patients with ST-elevation myocardial infarction. Am J Cardiol. 2011;108(11):1536–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Terkelsen CJ, Sorensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, Vach W, Johnsen SP, Thuesen L, Lassen JF. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA. 2010;304(7):763–71.CrossRefPubMedGoogle Scholar
  20. 20.
    Jager B, Farhan S, Kalla K, Glogar HD, Christ G, Karnik R, Norman G, Prachar H, Schreiber W, Kaff A, Podczeck-Schweighofer A, Weidinger F, Stefenelli T, Delle-Karth G, Laggner AN, Maurer G, Huber K, Vienna SRG. One-year mortality in patients with acute ST-elevation myocardial infarction in the Vienna STEMI registry. Wien Klin Wochenschr. 2015;127(13–14):535–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, Julian D, Lengyel M, Neumann FJ, Ruzyllo W, Thygesen C, Underwood SR, Vahanian A, Verheugt FW, Wijns W. Task force on the management of acute myocardial infarction of the European Society of C. management of acute myocardial infarction in patients presenting with ST-segment elevation. The task force on the Management of acute myocardial infarction of the European Society of Cardiology. Eur Heart J. 2003;24(1):28–66.CrossRefPubMedGoogle Scholar
  22. 22.
    Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M, Guidelines ESCCfP. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–45.CrossRefPubMedGoogle Scholar
  23. 23.
    Van de Werf F. Management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2003;24(1):28–66.CrossRefPubMedGoogle Scholar
  24. 24.
    Otten AM, Maas AH, Ottervanger JP, Kloosterman A, van ’t Hof AW, Dambrink JH, Gosselink AT, Hoorntje JC, Suryapranata H, de Boer MJ. Zwolle Myocardial Infarction study G. Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age. Eur Heart J Acute Cardiovasc Care. 2013;2(4):334–41.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, Montalescot G. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest. 2004;126(2):461–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Dziewierz A, Siudak Z, Rakowski T, Dubiel JS, Dudek D. Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty. J Thromb Thrombolysis. 2012;34(2):214–21.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Solhpour A, Chang KW, Arain SA, Balan P, Loghin C, McCarthy JJ, Vernon Anderson H, Smalling RW. Ischemic time is a better predictor than door-to-balloon time for mortality and infarct size in ST-elevation myocardial infarction. Catheter Cardiovasc Interv. 2016;87(7):1194. doi: 10.1002/ccd.26230.CrossRefPubMedGoogle Scholar
  28. 28.
    Saczynski JS, Yarzebski J, Lessard D, Spencer FA, Gurwitz JH, Gore JM, Goldberg RJ. Trends in prehospital delay in patients with acute myocardial infarction (from the Worcester Heart Attack Study). Am J Cardiol. 2008;102(12):1589–94.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Farshid A, Brieger D, Hyun K, Hammett C, Ellis C, Rankin J, Lefkovits J, Chew D, French J. Characteristics and Clinical Course of STEMI Patients who Received no Reperfusion in the Australia and New Zealand SNAPSHOT ACS Registry. Heart Lung Circ. 2016;25(2):132–9.CrossRefPubMedGoogle Scholar
  30. 30.
    De Luca G, van ’t Hof AW, Ottervanger JP, Hoorntje JC, Gosselink AT, Dambrink JH, de Boer MJ, Suryapranata H. Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty. Eur Heart J. 2005;26(7):662–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Dudek D, Mehran R, Dziewierz A, Witzenbichler B, Brodie BR, Kornowski R, Fahy M, Lansky AJ, Rakowski T, Legutko J, Bryniarski L, Stone GW. Impact of advanced age on the safety and effectiveness of paclitaxel-eluting stent implantation in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: the HORIZONS-AMI trial. Catheter Cardiovasc Interv. 2013;82(6):869–77.CrossRefPubMedGoogle Scholar
  32. 32.
    De Luca G, Dirksen MT, Spaulding C, Kelbaek H, Schalij M, Thuesen L, van der Hoeven B, Vink MA, Kaiser C, Musto C, Chechi T, Spaziani G, Diaz de la Lera LS, Pasceri V, Di Lorenzo E, Violini R, Suryapranata H, Stone GW. Impact of age on long-term outcome after primary angioplasty with bare-metal or drug-eluting stent (from the DESERT cooperation). Am J Cardiol. 2013;112(2):181–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Tentzeris I, Rohla M, Jarai R, Farhan S, Freynhofer MK, Unger G, Nurnberg M, Geppert A, Wessely E, Wojta J, Huber K. Influence of high-dose highly efficient statins on short-term mortality in patients undergoing percutaneous coronary intervention with stenting for acute coronary syndromes. Am J Cardiol. 2014;113(7):1099–104.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Paul Michael Haller
    • 1
    • 9
  • Bernhard Jäger
    • 1
    • 9
  • Serdar Farhan
    • 1
    • 9
  • Günter Christ
    • 2
    • 9
  • Wolfgang Schreiber
    • 3
    • 9
  • Franz Weidinger
    • 4
    • 9
  • Thomas Stefenelli
    • 5
    • 9
  • Georg Delle-Karth
    • 6
    • 9
  • Alfred Kaff
    • 7
    • 9
  • Gerald Maurer
    • 8
    • 9
  • Kurt Huber
    • 1
    • 9
  1. 1.3rd Medical Department, Cardiology and Intensive Care MedicineWilhelminenhospitalViennaAustria
  2. 2.5th Medial Department, CardiologySozialmedizinisches Zentrum SüdViennaAustria
  3. 3.Department of Emergency MedicineMedical University of ViennaViennaAustria
  4. 4.2nd Medical Department, CardiologyKrankenhaus RudolfstiftungViennaAustria
  5. 5.1st Medical Department, CardiologySozialmedizinisches Zentrum OstViennaAustria
  6. 6.4th Medical Department, CardiologyKrankenhaus HietzingViennaAustria
  7. 7.Ambulance Services ViennaViennaAustria
  8. 8.Department of CardiologyMedical University of ViennaViennaAustria
  9. 9.Vienna STEMI Registry GroupViennaAustria

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