Age-Related Differences in Reperfusion Therapy and Outcomes for ST-Segment Elevation Myocardial Infarction.

OBJECTIVES:

To compare timely access to reperfusion therapy and outcomes according to age of older adults with ST-segment elevation myocardial infarction (STEM) managed within an integrated regional system of care.

DESIGN:

Ongoing, prospective, regional, hospital-based clinical registry.

SETTING:

Twenty-three public and private hospitals in the Northern Alps in France.

PARTICIPANTS:

Individuals presenting with STEMI evolving for less than 12 hours from symptom onset between January 2009 and December 2015 (N=4,813; 3,716 (77.2%) <75, 782 (16.2%) 75-84, 315 (6.5%) ≥85).

MEASUREMENTS:

Delivery of any reperfusion therapy (primary percutaneous coronary intervention (PCI), intravenous fibrinolysis), primary PCI, and timely reperfusion therapy and in-hospital outcomes.

RESULTS:

The percentages of patients receiving any reperfusion therapy were 92.9% for those younger than 75, 89.0% for those aged 75 to 84, and 78.7% for those aged 85 and older (P < .001). The percentages of patients undergoing primary PCI were 63.7%, 70.3%, 72.4% (P < .001); and the percentages of patients receiving timely delivery of reperfusion therapy were 44.6%, 36.8%, 29.9% (P < .001). In-hospital all-cause mortality was 3.4% for those younger than 75, 10.2% for those aged 75 to 84, and 19.8% for those aged 85 and older (P <.001). In multivariable analysis adjusting for baseline characteristics, timely delivery of reperfusion therapy was associated with lower in-hospital mortality (adjusted odds ratio=0.63, 95% confidence interval=0.46-0.85) with no significant heterogeneity between age groups (P-value for interaction = .45).

CONCLUSION:

Older adults meeting contemporary eligibility criteria for reperfusion therapy continue to receive delayed reperfusion therapy and experience higher mortality than their younger counterparts.

© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.