Guidelines mandate urgent revascularization in patients presenting with ST-elevation
myocardial infarction (STEMI) irrespective of age. Whether this strategy is optimal
in patients aged ≥85 years remains uncertain. We aimed to assess the clinical characteristics
and outcomes of patients aged ≥85 years with STEMI stratified by their management
strategy. We analyzed baseline clinical characteristics of 101 consecutive patients
aged ≥85 years who presented with STEMI to a tertiary Australian hospital. Patients
were stratified based on whether they underwent invasive management with urgent coronary
angiography ± percutaneous coronary intervention or conservative management. Our primary
outcome was long-term mortality. Independent predictors of conservative management
and long-term mortality were assessed by multivariate logistic regression and Cox
proportional hazard modeling respectively. Of the 101 patients included, 45 underwent
invasive management. Independent predictors of having conservative management were
older age, anterior STEMI, and cognitive impairment (all p <0.01). Patients managed
invasively had lower in-hospital (13.3% vs 32.1%, p = 0.03), 30-day (13.3% vs 37.5%,
p <0.01), 12-month (22.2% vs 57.1%, p <0.01), and long-term (40.0% vs 75.0%, p <0.01)
mortality. Invasive management was an independent predictor of lower long-term mortality
(hazard ratio 0.29, 95% CI 0.11 to 0.76, p <0.01). In conclusion, patients aged ≥85 years
with STEMI who were older, had cognitive impairment or presented with anterior ST-elevation
were more likely to be managed conservatively. Those who underwent invasive management
had reasonable short- and long-term outcomes.
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Article Info
Publication History
Published online: April 21, 2016
Accepted:
April 8,
2016
Received in revised form:
April 8,
2016
Received:
February 9,
2016
Footnotes
Drs. Matias Yudi and Nicholas Jones contributed equally to this manuscript.
Dr. Yudi is supported by a combined National Health and Medical Research Council (NHMRC) and National Heart Foundation Postgraduate Scholarship (Australia).
See page 48 for disclosure information.
Identification
Copyright
Crown Copyright © 2016 Published by Elsevier Inc. All rights reserved.
