Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group.
BACKGROUND
ST-segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.


METHODS AND RESULTS
We analyzed 10 249 consecutive patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all-cause mortality at a median follow-up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In-hospital mortality (7.7% vs 2.4%, P<0.0001) and long-term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07-1.09, P<0.0001). Time-stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long-term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts.


CONCLUSIONS
In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in-hospital outcomes were reasonable, and long-term mortality rates were static.
['Bromage|Daniel I|DI|', 'Jones|Daniel A|DA|', 'Rathod|Krishnaraj S|KS|', 'Grout|Claire|C|', 'Iqbal|M Bilal|MB|', 'Lim|Pitt|P|', 'Jain|Ajay|A|', 'Kalra|Sundeep S|SS|', 'Crake|Tom|T|', 'Astroulakis|Zoe|Z|', 'Ozkor|Mick|M|', 'Rakhit|Roby D|RD|', 'Knight|Charles J|CJ|', 'Dalby|Miles C|MC|', 'Malik|Iqbal S|IS|', 'Mathur|Anthony|A|', 'Redwood|Simon|S|', 'MacCarthy|Philip A|PA|', 'Wragg|Andrew|A|']
D000369:Aged, 80 and over D016063:Blood Loss, Surgical D001803:Blood Transfusion D015331:Cohort Studies D003324:Coronary Artery Disease D005260:Female D017052:Hospital Mortality D006801:Humans D053208:Kaplan-Meier Estimate D008131:London D008297:Male D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D011183:Postoperative Complications D012042:Registries D000072657:ST Elevation Myocardial Infarction D015607:Stents D013997:Time Factors D016896:Treatment Outcome
outcome octogenarian primary percutaneous coronary intervention aging elderly complications acute myocardial infarction cardiovascular disease epidemiology