ST-elevation myocardial infarction in the elderly - Temporal Trends in incidence, utilization of percutaneous coronary intervention and outcomes in the United States.
Int J Cardiol. 2013 Jul 6;
Authors: Khera S, Kolte D, Palaniswamy C, Mujib M, Aronow WS, Singh T, Gotsis W, Silverman G, Frishman WH
Abstract
BACKGROUND: Elderly patients with ST-elevation myocardial infarction (STEMI) are often underrepresented in major percutaneous coronary intervention (PCI) trials. Use of PCI for STEMI, and associated outcomes in patients aged≥65years with STEMI needed further investigation.
METHODS: We used the 2001-2010 United States Nationwide Inpatient Sample (NIS) database to examine the temporal trends in STEMI, use of PCI for STEMI, and outcomes among patients aged 65-79 and≥80years.
RESULTS: During 2001-2010, of 4,017,367 patients aged ≥65years with acute myocardial infarction (AMI), 1,434,579 (35.7%) had STEMI. Over this period, among patients aged 65-79 and ≥80years, STEMI decreased by 16.4% and 19%, whereas the use of PCI for STEMI increased by 33.5% and 22%, respectively (Ptrend<0.001). There was a significant decrease in age-adjusted in-hospital mortality (per 1000) in patients aged ≥80years (150 versus 116, Ptrend=0.02) but not in patients aged 65-79years (63 versus 59, Ptrend=0.886). Stepwise logistic regression identified intra-aortic balloon pump use, acute renal failure, acute cerebrovascular disease, age≥80years, peripheral vascular disease, gastrointestinal bleeding, female gender, congestive heart failure, chronic lung disease, weekend admission and multivessel PCI as independent predictors of in-hospital mortality among all patients ≥65years of age who underwent PCI for STEMI.
CONCLUSIONS: In this large, multi-institutional cohort of elderly patients, a decreasing trend in STEMI, an increasing trend in PCI utilization for STEMI, and reduction in in-hospital mortality were observed from 2001 to 2010.
PMID: 23838593 [PubMed - as supplied by publisher]