Changing Trends in, and Characteristics Associated with, Not Undergoing Cardiac Catheterization in Elderly Adults Hospitalized with ST‐Segment Elevation Acute Myocardial Infarction

Abstract

Objectives Little data existaboutthe magnitude and characteristics ofelderly patientswho are hospitalized foran ST-segment elevation acute myocardial infarction (STEMI)who do not undergo cardiac catheterization and/ora percutaneous coronary intervention (PCI).Our study objectives were to describe decade long trends (1999-2009)in the rates of not undergoingcardiaccatheterizationand PCI among patients>65 years old presenting with an STEMI and factors associated with not undergoing these procedures. Design Observational study. Setting Population-based study. Participants 960residents of theWorcester (MA) metropolitan area 65 years and older who were hospitalized for an STEMI in 6 biennial periods between 1999 and 2009 at all 11central MA medical centers. Measurements Analyses were conducted to examine the characteristics of patients who did not undergo cardiac catheterization overall, and further stratified into 2 age strata (65-74 years and >75 years) Results Between 1999and 2009, dramatic declines (from 59.4% to 7.5%)were observed in the proportion ofolder patients who did not undergo cardiac catheterization at all greater Worcester hospitalsThese declines were observed in patients65-74 yearsold (58.4%to6.7%) as well as in patients 75 years and older(69.4% to13.5%).The proportion of patients not receiving a PCI after undergoing a cardiac catheterization decreased from 36.6% (in 1999) to 6.5% (in 2009). Women, patients with a prior MI, those with do not resuscitate orders, and patients withvarious comorbidities were less likely to have undergone these procedures thanrespective comparison groups. Conclusion Older patients who develop an STEMI are increasingly likely to undergo cardiac catheterizationand a PCI but several high risk groups remain less likely to undergo these procedures.

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

“…(25) These trends were similar in the United States and Europe. (26)(27)(28) The Acute Myocardial Infarction in Switzerland Plus Registry examined hospital admission in older adults (≥75 years of age) with STEMI and shock from 1997 to 2006. (29) The rate of utilization of PCI or thrombolysis was significantly lower in older adults (older adults: 15.1% vs. younger adults 39.7%) but there was a parallel decrease in mortality rate between 1997 and 2006 from 82.8% to 75.6%.…”

Gender‐related differences in elderly patients with myocardial infarction in a European Centre

“…recently reported similar findings within the northern American area in patients 65 years of age or older. They were able to demonstrate that the rate of conservative therapy in elderly ST elevation myocardial infarction (STEMI) patients (> 75 years of age) significantly decreased from 1999 (69·4%) to 2009 (13·5%) . They found that female patients, those with a prior AMI, and patients who did not present with typical chest pain were less likely to undergo cardiac catheterization.…”

Acute myocardial infarction in the elderly

“…To be included in this cohort, the elderly STEMI patient had to reach the cathlab and they had to survive the primary angioplasty procedure. In a paper entitled ‘Changing trends in, and characteristics associated with, NOT undergoing cardiac catheterisation in elderly adults hospitalised with ST-segment elevation acute myocardial infarction’, Tisminetzky et al describe the decade long (1999–2009) trends in the rate of NOT undergoing angiography and angioplasty and the factors associated with not undergoing these procedures in an observational population-based study in the setting of Worchester, Massachusetts [ 2 ]. Older adults who develop STEMI are increasingly likely to undergo cardiac catheterisation and angioplasty, but several high-risk groups often still do not make it to the cathlab, including women, individuals with prior infarction and those with various comorbidities.…”