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Treatment choices in elderly patients with ST: elevation myocardial infarction-insights from the Vital Heart Response registry.

Toleva O, Ibrahim Q, Brass N, Sookram S, Welsh R - Open Heart (2015)

Bottom Line: Time from symptoms to first medical contact (median, 93 vs 78 min p=0.008) and PPCI (median, 166 vs 136 min (p<0.001) were longer for ≥75 years.In those ≥75 years outcomes by reperfusion (PPCI, fibrinolysis and none) were: in-hospital death 13.3%, 9.4% and 19.7% (p=0.018), and composite of death, recurrent-MI, cardiogenic shock and congestive heart failure 28%, 20% and 33.2% (p=0.022).Acknowledging physician selection of the reperfusion strategy; outcomes appear favourable in the elderly receiving fibrinolysis.

View Article: PubMed Central - PubMed

Affiliation: University of Alberta , Edmonton, Alberta , Canada.

ABSTRACT

Background: Management of elderly patients with ST elevation myocardial infarction (STEMI) is challenging and they are under-represented in trials. Accordingly, we analysed reperfusion strategies and their effectiveness in patients with STEMI ≥75 years compared to <75 years within a comprehensive inclusive registry.

Methods: Consecutive patients with STEMI admitted to hospital and tracked within a regional registry (2006-2011) were analysed comparing reperfusion strategy (primary percutaneous coronary intervention (PPCI), fibrinolysis and no reperfusion) between patients ≥75 vs <75 years old as well as across the reperfusion strategies in those ≥75 years.

Results: There were 3588 patients with STEMI with 646 (18%) ≥75 years old. Elderly patients were more likely female (46.9% vs 18.4%) and had more prior: angina (28.2% vs 17.2%), myocardial infarction (MI; 22.8% vs 13.9%), hypertension (67.6% vs 44.2%), heart failure (2.3% vs 0.3%) and atrial fibrillation (2.2% vs 0.5%) (all p<0.001). The reperfusion strategy for patients ≥75 vs <75: PPCI 45.3% vs 41.2%, fibrinolysis 24.8% vs 45.7%, and no reperfusion 29.9% vs 13.1% (p<0.001). Time from symptoms to first medical contact (median, 93 vs 78 min p=0.008) and PPCI (median, 166 vs 136 min (p<0.001) were longer for ≥75 years. In those ≥75 years outcomes by reperfusion (PPCI, fibrinolysis and none) were: in-hospital death 13.3%, 9.4% and 19.7% (p=0.018), and composite of death, recurrent-MI, cardiogenic shock and congestive heart failure 28%, 20% and 33.2% (p=0.022).

Conclusions: Elderly patients have more comorbidities, worst in-hospital clinical outcomes and are less likely to receive reperfusion. Acknowledging physician selection of the reperfusion strategy; outcomes appear favourable in the elderly receiving fibrinolysis.

No MeSH data available.


Related in: MedlinePlus

Reperfusion strategies among patients with STEMI by age in Alberta, 2006–2011. The figure represents applied reperfusion strategy by age groups (<50, 50–60, 60–70, 70–80 and ≥80) separated into: medical therapy without reperfusion (black ⧍), fibrinolysis (yellow ⧫) and primary percutaneous coronary intervention PCI (red □).
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OPENHRT2014000235F1: Reperfusion strategies among patients with STEMI by age in Alberta, 2006–2011. The figure represents applied reperfusion strategy by age groups (<50, 50–60, 60–70, 70–80 and ≥80) separated into: medical therapy without reperfusion (black ⧍), fibrinolysis (yellow ⧫) and primary percutaneous coronary intervention PCI (red □).

Mentions: The implementation of various reperfusion strategies by 10-year age increments starting at <50 years and ending at >80 years showed that with increasing age there is increased use of no reperfusion therapy, decreased use of fibrinolysis and similar usage of PPCI (figure 1). PPCI was performed in 45% vs 41% (p=0.054), fibrinolysis in 25% vs 46% (<0.001) and no reperfusion therapy in 30% vs 13% (p<0.001) in those ≥75 years old and <75 years old respectively. Intravenous glycoprotein IIb/IIIa receptor inhibitors during index hospitalisation were utilised in 26.3% and 43.8% (p<0.001), respectively. In patients ≥75 years they were utilised during index hospitalisation in 43.8% receiving PPCI and 15.2% receiving fibrinolysis whereas in those <75 years they were utilised in 71.7% receiving PPCI and 29.2% receiving fibrinolysis.


Treatment choices in elderly patients with ST: elevation myocardial infarction-insights from the Vital Heart Response registry.

Toleva O, Ibrahim Q, Brass N, Sookram S, Welsh R - Open Heart (2015)

Reperfusion strategies among patients with STEMI by age in Alberta, 2006–2011. The figure represents applied reperfusion strategy by age groups (<50, 50–60, 60–70, 70–80 and ≥80) separated into: medical therapy without reperfusion (black ⧍), fibrinolysis (yellow ⧫) and primary percutaneous coronary intervention PCI (red □).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488892&req=5

OPENHRT2014000235F1: Reperfusion strategies among patients with STEMI by age in Alberta, 2006–2011. The figure represents applied reperfusion strategy by age groups (<50, 50–60, 60–70, 70–80 and ≥80) separated into: medical therapy without reperfusion (black ⧍), fibrinolysis (yellow ⧫) and primary percutaneous coronary intervention PCI (red □).
Mentions: The implementation of various reperfusion strategies by 10-year age increments starting at <50 years and ending at >80 years showed that with increasing age there is increased use of no reperfusion therapy, decreased use of fibrinolysis and similar usage of PPCI (figure 1). PPCI was performed in 45% vs 41% (p=0.054), fibrinolysis in 25% vs 46% (<0.001) and no reperfusion therapy in 30% vs 13% (p<0.001) in those ≥75 years old and <75 years old respectively. Intravenous glycoprotein IIb/IIIa receptor inhibitors during index hospitalisation were utilised in 26.3% and 43.8% (p<0.001), respectively. In patients ≥75 years they were utilised during index hospitalisation in 43.8% receiving PPCI and 15.2% receiving fibrinolysis whereas in those <75 years they were utilised in 71.7% receiving PPCI and 29.2% receiving fibrinolysis.

Bottom Line: Time from symptoms to first medical contact (median, 93 vs 78 min p=0.008) and PPCI (median, 166 vs 136 min (p<0.001) were longer for ≥75 years.In those ≥75 years outcomes by reperfusion (PPCI, fibrinolysis and none) were: in-hospital death 13.3%, 9.4% and 19.7% (p=0.018), and composite of death, recurrent-MI, cardiogenic shock and congestive heart failure 28%, 20% and 33.2% (p=0.022).Acknowledging physician selection of the reperfusion strategy; outcomes appear favourable in the elderly receiving fibrinolysis.

View Article: PubMed Central - PubMed

Affiliation: University of Alberta , Edmonton, Alberta , Canada.

ABSTRACT

Background: Management of elderly patients with ST elevation myocardial infarction (STEMI) is challenging and they are under-represented in trials. Accordingly, we analysed reperfusion strategies and their effectiveness in patients with STEMI ≥75 years compared to <75 years within a comprehensive inclusive registry.

Methods: Consecutive patients with STEMI admitted to hospital and tracked within a regional registry (2006-2011) were analysed comparing reperfusion strategy (primary percutaneous coronary intervention (PPCI), fibrinolysis and no reperfusion) between patients ≥75 vs <75 years old as well as across the reperfusion strategies in those ≥75 years.

Results: There were 3588 patients with STEMI with 646 (18%) ≥75 years old. Elderly patients were more likely female (46.9% vs 18.4%) and had more prior: angina (28.2% vs 17.2%), myocardial infarction (MI; 22.8% vs 13.9%), hypertension (67.6% vs 44.2%), heart failure (2.3% vs 0.3%) and atrial fibrillation (2.2% vs 0.5%) (all p<0.001). The reperfusion strategy for patients ≥75 vs <75: PPCI 45.3% vs 41.2%, fibrinolysis 24.8% vs 45.7%, and no reperfusion 29.9% vs 13.1% (p<0.001). Time from symptoms to first medical contact (median, 93 vs 78 min p=0.008) and PPCI (median, 166 vs 136 min (p<0.001) were longer for ≥75 years. In those ≥75 years outcomes by reperfusion (PPCI, fibrinolysis and none) were: in-hospital death 13.3%, 9.4% and 19.7% (p=0.018), and composite of death, recurrent-MI, cardiogenic shock and congestive heart failure 28%, 20% and 33.2% (p=0.022).

Conclusions: Elderly patients have more comorbidities, worst in-hospital clinical outcomes and are less likely to receive reperfusion. Acknowledging physician selection of the reperfusion strategy; outcomes appear favourable in the elderly receiving fibrinolysis.

No MeSH data available.


Related in: MedlinePlus