Abstract 2864: Increase in Use of Guidelines-Recommended Treatments is Associated with a Reduction in Mortality in Elderly Patients Admitted for Acute Myocardial Infarction. Results from the “Registre Franc Comtois des Sydromes Coronariens Aigus”: 2001 versus 2005
Background: Among patients (pts) admitted for acute myocardial infarction (MI), elderly patients (>70 years) often receive less guidelines-recommended treatments and are at higher risk for mortality. In this population, changes in management between 2001 and 2005 and the impact of these changes on 30 day mortality, are poorly documented.
Methods: Demographic and baseline data, acute management and 1 month mortality data from a prospective, multicenter registry including all cardiology centers in the Franche-Comte region of France (1.2 million inhabitants, 10 centers) were recorded in 2001, and compared with the same data recorded in 2005. Pts were stratified according to the period and age (elderly versus non elderly).
Results: A total of 1479 pts were admitted for acute MI, 754 pts (421 NSTEMI and 333 STEMI) in 2001 and 725 (364 STEMI and 361 NSTEMI) in 2005. Elderly pts represented the half the population in both cohorts (52%, mean age 79±7 in 2001 and 49%, mean age 80±7 in 2005). Clinical characteristics were similar in both cohorts. Compared to 2001, there was a significant increase in 2005 in the rate of use of oral antiplatelet agents, ACE inhibitors and statins in both types of MI. In STEMI pts, there was an increase in reperfusion therapy: more eligible pts (61% vs 74%) and more reperfusion actually used in eligible patients (46% vs 66%). Similarly, there was an increase among NSTEMI patients in the use of GPIIb/IIIa inhibitors (20% vs 46%). At 1 month, there was a significant reduction in all-cause mortality rates, 12.8% (50/391) in 2001 versus 6.6% (27/406), p=0.003. This reduction in mortality was mainly observed in STEMI patients (table⇓).
Conclusions: In pts older than 70 years, we observed a significant increase in the rate of use of recommended treatments in 2005 as compared with a similar cohort in 2001. Despite similar clinical characteristics in both cohorts, there was a huge and significant reduction in 1 month mortality in STEMI patients.