Abstract 1995: Six-month Clinical Outcome Of Elderly Patients With St-elevation MI According To Reperfusion: Data From The French FAST-MI Registry
Background: Demographic changes in Western countries’ population have resulted in an increase in the number of elderly patients hospitalized for STEMI. There is a wide gap between the proportion of myocardial infarction in patients aged 75 years or older in Western countries and their enrolment in randomized controlled trials on ACS
Objective: To assess 6-month mortality of STEMI patients ≥ 75 years old in the French registry of Acute ST elevation or non-ST-elevation Myocardial Infarction (FAST-MI).
Methods: FAST-MI is a prospective multi-centre study (223 French institutions, university teaching hospitals, general and regional hospitals and private clinics with intensive care units), including all patients admitted to UCIs for AMI over a 1-month period in November 2005.
Results: 520 STEMI patients admitted within 48 hours after symptoms onset were ≥ 75 years old (30.6% of the STEMI population (n=1701). Mean age was 82.3 ±5.1 and 52.5% were women. Only 38.5% of the patients were treated by reperfusion therapy: 23.65% underwent primary angioplasty; 9% pre-hospital thrombolysis, 5.8% in-hospital thrombolysis. Six-month mortality rate was: 17.9% after angioplasty; 5.2% after pre-hospital lysis, 5.2% after in-hospital lysis and 71.6% for patients without reperfusion therapy, p= 0.037. By multivariate analysis, independent predictors of 6-month mortality were : smoking (or prior) (OR= 1.95, 95% CI= 1.16–3.3, p=0.012), heart failure (OR= 5.7, 95% CI= 3.2–10.1, p<0.0001), anterior location of MI (OR= 1.7, 95% CI= 1.1–2.8, p=0.022), systolic pressure at admission (OR=0.98, 95% CI= 0.97–0.98, p<0.0001), primary angioplasty (OR= 0.48, 95% CI= 0.26 – 0.86, p=0.014), pre-hospital thrombolysis (OR= 0.55, 95% CI= 0.2–1.4, ns), hospital thrombolysis (OR= 0.56, 95% CI= 0.2–1.6, ns).
Conclusion: In the absence of specific guidelines on treatment of elderly patients with STEMI, these real-world data show that reperfusion therapy is associated with improved survival at 6 months.