Age Related Outcomes in Patients Undergoing Transfer for Direct Percutanous Coronary Intervention in ST-Elevation Myocardial Infarction
Study of:
Age Related Outcomes in Patients Undergoing Transfer for Direct Percutanous Coronary Intervention in ST-Elevation Myocardial Infarction
Background:
Elderly patients account for the majority of death in STEMI and are frequently excluded from reperfusion therapy. Despite this, data regarding outcomes of percutaneous coronary intervention (PCI) in STEMI in the elderly is limited, including no data regarding transfer of elderly pts with STEMI.
Methods:
732 consecutive STEMI pts presented to (n=158) or were transferred to (n= 574) Abbott Northwestern Hospital for direct PCI. These pts were divided into age groups (<60 (n=335), 60-69 (n=141), 70-79 (n=147), and ≥80 yo (n=109)) and followed for major adverse cardiac events (MACE), including death, reinfarction or revascularization, and stroke. No pts were excluded, including cardiogenic shock (14%) and out of hospital cardiac arrest (11%).
Results:
No deaths occurred during transfer in any age group. In hospital, 30 day, and 1 year mortality in the ≥80 yo age group was significantly increased when compared to that of the other groups (see table). At 1 year, 6 of 17 deaths in the ≥80 yo group were noncardiac deaths.
|
% |
<60 years old (n=335) |
60-69 years old (n=141) |
70-79 years old (n=147) |
≥80 years old (n=109) |
p-value |
|
Mortality (in hosp) |
1.5% |
2.1% |
4.8% |
11.9% |
<0.0001 |
|
Mortality (30 d) |
1.8% |
2.1% |
4.8% |
15.6% |
<0.0001 |
|
1 year survival |
98.2 |
97.2 |
91.2 |
80.7 |
<0.0001 |
|
Reinfarction / revascularizaiton (30 d) |
1.2% |
2.2% |
1.4% |
0.9% |
0.81 |
|
Stroke (30 d) |
0.6% |
1.4% |
2% |
3.7% |
0.09 |
|
MACE (30 d) |
3.6% |
5.7% |
8.2% |
20% |
<0.0001 |
Conclusions:
Pts are safely transferred for direct PCI regardless of age. Not unexpectedly, pts ≥80 yo have increased mortality compared to younger pts, but 35% were non cardiac deaths. Despite the increase in mortality in pts ≥80 yo, this data compares favorably to previous studies of selected elderly with STEMI and are much lower than published data in octogenarians with STEMI. Our data suggest that all STEMI pts should be offered transfer for PCI, regardless of age.
Ivan J. Chavez, MD, FACC
Timothy D. Henry, MD, FACC
Wesley R. Pedersen, MD, FACC
Jay H. Traverse, MD, FACC, FAHA
Katie Menssen
Barbara Unger, RN, BS, FAACVPR
For more information about this study or other research studies at the Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, please contact Katie Menssen at 612-775-3052.
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