Impact of age on treatment and outcomes in ST-elevation myocardial infarction

Newell, Marc C.; Henry, Jason; Henry, Timothy D.; Duval, Sue; Browning, Joseph A.; Christiansen, Ellen C.; Larson, David M.; Berger, Alan K.

doi:10.1016/j.ahj.2010.12.018

Cited by 46 publications

(35 citation statements)

References 36 publications

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“…6,[12][13][14] It was apparent from our own clinical experience that the care of patients who develop STEMI after hospital admission was frequently suboptimal. Therefore, we applied the same standardized STEMI protocol in-hospital, and the results have been gratifying.…”

Section: Discussionmentioning

confidence: 99%

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

et al. 2014

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Section: Discussionmentioning

confidence: 99%

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

et al. 2014

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“…23,24 There are also limited data from routine practice on the difference in clinical outcomes among elderly patients by MI classification. [25][26][27] A previous analysis focusing on NSTEMI patients from the CRUSADE Registry (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guideline) reported high rates of mortality and nonfatal cardiovascular outcomes among elderly patients through 5 years, regardless of the management strategy, but patients with STEMI were not routinely included in this registry. 4 Our results, therefore, provide valuable insights into the trajectory and occurrence of ischemic outcomes among elderly acute MI patients who were stratified by MI classification and may inform sample size calculations for future secondary prevention clinical trials of patients with acute MI.…”

Section: Discussionmentioning

confidence: 99%

Differences in Short- and Long-Term Outcomes Among Older Patients With ST-Elevation Versus Non–ST-Elevation Myocardial Infarction With Angiographically Proven Coronary Artery Disease

Vora

Wang

Hellkamp

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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O utcomes among patients presenting with ST-segmentelevation myocardial infarction (STEMI) and non-STsegment-elevation myocardial infarction (NSTEMI) have improved markedly because of a combination of rapid recognition of the myocardial infarction (MI) event, early invasive management with revascularization, and aggressive secondary prevention treatment strategies. Previous studies have demonstrated differential short-and long-term mortality risks by MI classification (STEMI versus NSTEMI).1-4 Although patients presenting with STEMI have been demonstrated to have a higher risk of early mortality, 4 patients presenting with NSTEMI have been shown to have a higher risk of long-term mortality that has been attributed to the higher burden of comorbidities and a greater prevalence of multivessel coronary disease in these patients. 1Notwithstanding these findings, most studies that observed differential risks of long-term outcomes between STEMI and NSTEMI patients included younger populations of patients Background-Among older patients with acute myocardial infarction (MI), it remains uncertain whether there is a timedependent difference in the risk of recurrent mortality and nonfatal cardiovascular and cerebrovascular events for those with ST-segment-elevation MI (STEMI) compared with those with non-ST-segment-elevation MI. Methods and Results-Older patients ≥65 years with acute MI and significant coronary artery disease identified with coronary angiography from the ACTION Registry-GWTG (Get With the Guidelines) were linked to Medicare claims data from 2007 to 2010. We examined the unadjusted cumulative incidence of each outcome studied from hospital discharge through 2 years with log-rank tests and then performed a piece-wise proportional hazards modeling with 2 time periods: discharge to 90 days and 90 days to 2 years. Among the 46 199 patients linked with Medicare data, 17 287 (37.4%) presented with STEMI. Through 2 years, the unadjusted cumulative incidence of all-cause mortality (16.0% versus 19.8%; P<0.001) and the composite outcome (21.9% versus 27.9%; P<0.001) was lower for STEMI patients. Within the first 90 days, unadjusted rates of mortality (5.5% versus 5.3%) and the composite outcome (7.9% versus 8.1%) were similar but diverged from 90 days to 2 years (mortality, 11.1% versus 15.4%; P<0.001; composite outcome, 15.2% versus 21.5%; P<0.001). After multivariable adjustment, the adjusted risks of mortality and the composite outcome through 90 days were higher for STEMI patients, whereas risks of mortality and the composite outcome were attenuated from 90 days through 2 years. Conclusions-Among older acute MI patients with angiographically confirmed coronary artery disease discharged alive, STEMI patients (compared with non-ST-segment-elevation MI patients) were found to have a lower frequency of unadjusted postdischarge mortality and composite cardiovascular and cerebrovascular outcomes through 2 years after hospital discharge. This analysis provides unique insight into differential short-and long-term risks...

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“…The proportion of octogenarians in the general population is expected to triple by the year 2050 1. Even though octogenarians constitute an important high-risk subgroup of patients with STEMI, they are frequently under-represented in clinical trials, and advanced age is considered an independent risk factor for the early morbidity and mortality associated with PCI for STEMI 2,3. Poorer outcome is influenced not only by extensive coronary artery disease but also by more complex comorbidities 4.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction

Gao¹,

Liu²,

Qin³

et al. 2014

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As a result of increased life expectancy, octogenarians constitute an increasing proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes.

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Impact of age on treatment and outcomes in ST-elevation myocardial infarction

Cited by 46 publications

References 36 publications

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

Differences in Short- and Long-Term Outcomes Among Older Patients With ST-Elevation Versus Non–ST-Elevation Myocardial Infarction With Angiographically Proven Coronary Artery Disease

Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction

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