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

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Vandecasteele, Els H De Buyzere, Marc Gevaert, Sofie de Meester, Antoine Convens, Carl Evrard, Patrick [UCL] Beauloye, Christophe [UCL] Claeys, Marc J

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. © 2013 Springer-Verlag Berlin Heidelberg.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2013
Language Anglais
Journal information "Clinical Research in Cardiology" - Vol. 102, no.11, p. 837-845 (2013)
Peer reviewed yes
Publisher Springer Medizin ((Germany) Heidelberg)
issn 1861-0684
e-issn 1861-0692
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - (MGD) Services des soins intensifs
UCL - (SLuc) Service de cardiologie
MESH Subject Age Factors ; Myocardial Reperfusion ; Percutaneous Coronary Intervention ; Prevalence ; Prospective Studies ; Registries ; Thrombolytic Therapy ; Time Factors ; Treatment Outcome ; Aged, 80 and over ; Belgium ; Female ; Heart Failure ; Hospital Mortality ; Humans ; Male ; Myocardial Infarction
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Bibliographic reference Vandecasteele, Els H ; De Buyzere, Marc ; Gevaert, Sofie ; de Meester, Antoine ; Convens, Carl ; et. al. Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry. In: Clinical Research in Cardiology, Vol. 102, no.11, p. 837-845 (2013)
Permanent URL http://hdl.handle.net/2078.1/156827