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Outcomes and quality of life in patients>or=85 years of age with ST-elevation myocardial infarction.
Am J Cardiol. 2009 Jan 15;103(2):170-4
Authors: Shah P, Najafi AH, Panza JA, Cooper HA
The oldest old comprise the fastest growing segment of the US population. However, data are limited regarding the treatment and outcomes of ST-segment elevation myocardial infarction (STEMI) in this age group. We analyzed consecutive patients with STEMI>or=85 years old at a single center. Quality of life was assessed using the EQ-5D Index (range -0.11 to 1.00) and EQ-VAS (range 0 to 100). Of 1,847 patients admitted from 2002 to 2007 with STEMI, 73 (4%) were >or=85 years old (range 85 to 94). Median time from symptom onset to hospital arrival was 3 hours. Cardiogenic shock occurred in 33%. Primary percutaneous coronary intervention (PCI) was performed in 70% of patients, and the procedural success rate was 94%. Evidenced-based therapy included aspirin (97%), clopidogrel (93%), beta blockers (82%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (74%), and statins (86%). The in-hospital mortality rate was 32%, and it was 54% in those with cardiogenic shock. Long-term follow-up was obtained in 96% of hospital survivors at a median of 429 days. Survival rates in patients discharged alive were 75% at 1 year and 65% at 2 years. Cardiogenic shock was the only independent predictor of in-hospital mortality (odds ratio 3.8, 95% confidence interval 1.2 to 11.7, p=0.02), and primary PCI was the only independent predictor of long-term survival (hazard ratio 0.3, 95% confidence interval 0.1 to 0.8, p=0.02). Mean EQ-5D Index was 0.78 and mean EQ-VAS was 70.5. In conclusion, in the oldest old with STEMI, aggressive treatment is associated with reasonable long-term survival and excellent quality of life. The exception may be patients presenting with cardiogenic shock, for whom short-term mortality remains exceedingly high.
PMID: 19121431 [PubMed - in process]