Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Yeh RW, Sidney S, Chandra M et al (2010) Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 362:2155–2165

    Article  PubMed  CAS  Google Scholar 

  2. Claessen BE, Kikkert WJ, Engstrom AE et al (2010) Primary percutaneous coronary intervention for ST elevation myocardial infarction in octogenarians: trends and outcomes. Heart 96:843–847

    Article  PubMed  Google Scholar 

  3. Gottlieb S, Behar S, Hod H et al (2007) Trends in management, hospital and long-term outcomes of elderly patients with acute myocardial infarction. Am J Med 120:90–97

    Article  PubMed  Google Scholar 

  4. Alexander KP, Newby K, Armstrong PW et al (2007) Acute coronary care in the elderly, Part II ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology in collaboration with the Society of Geriatric Cardiology. Circulation 115:2570–2589

    Article  PubMed  Google Scholar 

  5. Gottlieb S, Behar S, Schwartz R et al (2011) Age differences in the adherence to treatment guidelines and outcome in patients with ST-elevation myocardial infarction. Arch Gerontol Geriatr 52:118–124

    Article  PubMed  Google Scholar 

  6. Rathore SS, Mehta RH, Wang Y et al (2003) Effects of age on the quality of care provided to older patients with acute myocardial infarction. Am J Med 114:307–315

    Article  PubMed  Google Scholar 

  7. Magid DJ, Masoudi FA, Vinson DR et al (2005) Older emergency department patients with acute myocardial infarction receive lower quality of care than younger patients. Ann Emerg Med 46:14–21

    Article  PubMed  Google Scholar 

  8. Martin AC, Monsegu J (2010) Syndrome coronaire aigu avec élévation du segment ST chez l’ octogénaire. Ann Cardiol Angeiol (Paris) 59:349–355

    Article  Google Scholar 

  9. Bueno H, Betriu A, Heras M et al (2011) Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J 32:51–60

    Article  PubMed  Google Scholar 

  10. Grines C (2005) SENIOR PAMI: a prospective randomised trial of primary angioplasty and thrombolytic therapy in elderly patients with acute myocardial infarction. Presented at Transcatheter Cardiovascular Therapeutics, Washington

  11. Morrow DA, Antman EM, Charlesworth A et al (2000) TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 102:2031–2037

    Article  PubMed  CAS  Google Scholar 

  12. Schwarz AK, Zahn R, Hochadel M et al (2011) Age-related differences in antithrombotic therapy, success rate and in-hospital mortality in patients undergoing percutaneous coronary intervention: results of the quality control registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Clin Res Cardiol 100:773–780

    Article  PubMed  CAS  Google Scholar 

  13. Fox CS, Muntner P, Chen AY et al (2010) Use of evidence-based therapies in short-term outcomes of ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in patients with chronic kidney disease: a report from the National Cardiovascular Data Acute Coronary Treatment and Intervention Outcomes Network Registry. Circulation 121:357–365

    Article  PubMed  CAS  Google Scholar 

  14. Miyamoto T, Obayashi T, Hattori E et al (2010) Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction. J Med Dent Sci 57:119–126

    PubMed  Google Scholar 

  15. Danzi GB, Centola M, Pomidossi GA et al (2010) Usefulness of primary angioplasty in nonagenarians with acute myocardial infarction. Am J Cardiol 106:770–773

    Article  PubMed  Google Scholar 

  16. Sheifer SE, Rathore SS, Gersh BJ et al (2000) Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic characteristics. Circulation 102:1651–1656

    Article  PubMed  CAS  Google Scholar 

  17. Gharacholou SM, Lopes RD, Alexander KP et al (2011) Age and outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Arch Intern Med 171:559–567

    Article  PubMed  Google Scholar 

  18. Matsui K, Fukui T, Hira K et al (2002) Impact of sex and its interaction with age on the management of and outcome for patients with acute myocardial infarction in 4 Japanese hospitals. Am Heart J 144:101–107

    Article  PubMed  Google Scholar 

  19. Thiemann DR, Coresh J, Schulman SP et al (2000) Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 101:2239–2246

    Article  PubMed  CAS  Google Scholar 

  20. Van de Werf F, Bax J, Betriu A et al (2008) 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 29:2909–2945

    Article  PubMed  Google Scholar 

  21. Kushner FG, Hand M, Smith SC Jr et al (2009) 2009 Focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report from the American college of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol 54(23):2205–2241

    Article  PubMed  Google Scholar 

  22. White HD (2000) Thrombolytic therapy in the elderly. Lancet 356:2028–2030

    Article  PubMed  CAS  Google Scholar 

  23. von Scheidt W, Thilo C (2011) As time goes by?: the fallacy of thrombolysis in STEMI networks. Clin Res Cardiol 100:867–877

    Article  Google Scholar 

  24. Lesnefsky EJ, Lundergan CF, Hodgson JM et al (1996) Increased left ventricular dysfunction in elderly patients despite successful thrombolysis: the GUSTO-I angiographic experience. J Am Coll Cardiol 28:331–337

    Article  PubMed  CAS  Google Scholar 

  25. Sinnaeve PR, Huang Y, Bogaerts K et al (2006) Age, outcomes, and treatment effects of fibrinolytic and antithrombotic combinations: findings from assessment of the safety and efficacy of a new thrombolytic (ASSENT)-3 and ASSENT-3 Plus. Am Heart J 152:684e1-9

    Article  Google Scholar 

  26. Mehta RH, Granger CB, Alexander KP et al (2005) Reperfusion strategies for acute myocardial infarction in the elderly: benefits and risks. J Am Coll Cardiol 45:471–478

    Article  PubMed  Google Scholar 

  27. Shelton RJ, Crean AM, Somers K et al (2010) Real-world outcome from ST elevation myocardial infarction in the very elderly before and after introduction of a 24/7 primary percutaneous coronary intervention service. Am Heart J 159:956–963

    Article  PubMed  Google Scholar 

  28. Carro A, Bastiaenen R, Kaski JC (2011) Age related issues in reperfusion of myocardial infarction. Cardiovasc Drugs Ther 25:139–148

    Article  PubMed  Google Scholar 

  29. Widimsky P, Wijns W, Fajadet J et al (2010) Reperfusion therapie for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 31:943–957

    Article  PubMed  Google Scholar 

  30. Claeys MJ, de Meester A, Convens C et al (2011) Contemporary mortality differences between primary percutaneous coronary intervention and thrombolysis in ST-segment elevation myocardial infarction. Arch Intern Med 171:544–549

    Article  PubMed  Google Scholar 

  31. Gibson CM, Pride YB, Frederick PD et al (2008) Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in-hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the national registry of myocardial infarction from 1990 to 2006. Am Heart J 156:1035–1044

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Cardiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Els H. Vandecasteele, Marc De Buyzere & Sofie Gevaert

  2. Hôpital de Jolimont, Haine-Saint-Paul, Hainaut, Belgium

    Antoine de Meester

  3. ZNA, Antwerpen, Belgium

    Carl Convens

  4. CHU, Charleroi, Belgium

    Philippe Dubois

  5. CHR Citadelle Liège, Liège, Belgium

    Jean Boland

  6. UZ, Leuven, Belgium

    Peter Sinnaeve

  7. OLV Ziekenhuis Aalst, Aalst, Belgium

    Herbert De Raedt

  8. Virga Jesse Hasselt, Hasselt, Belgium

    Pascal Vranckx

  9. AZ Sint-Jan Brugge, Brugge, Belgium

    Patrick Coussement

  10. UCL Mont-Godinne, Yvoir, Belgium

    Patrick Evrard

  11. UCL Louvain-la-Neuve, Louvain-la-Neuve, Belgium

    Christophe Beauloye

  12. ULB Brussels, Brussels, Belgium

    Marc Renard

  13. UZ Antwerpen, Antwerpen, Belgium

    Marc J. Claeys

Authors
  1. Els H. Vandecasteele
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc De Buyzere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sofie Gevaert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antoine de Meester
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carl Convens
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philippe Dubois
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean Boland
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter Sinnaeve
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Herbert De Raedt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pascal Vranckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Patrick Coussement
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Patrick Evrard
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Christophe Beauloye
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Marc Renard
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Marc J. Claeys
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Els H. Vandecasteele.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vandecasteele, E.H., De Buyzere, M., Gevaert, S. et al. Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry. Clin Res Cardiol 102, 837–845 (2013). https://doi.org/10.1007/s00392-013-0600-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-013-0600-3

Keywords

Search

Navigation