Abstract 4692: Outcomes of Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction in Octogenarians
BACKGROUND: Primary percutaneous coronary intervention (PPCI) with goal door-to-balloon time <90 minutes is the choice reperfusion strategy in ST-segment elevation myocardial infarction (STEMI). However, there is little data on outcome for octogenarians undergoing PPCI for acute STEMI. The aim of this study was to describe clinical characteristics and outcome in patients 80 years of age or older who were treated with PPCI.
METHODS: We identified a cohort of 790 consecutive STEMI patients (69% male, n=547; median age 61 years, range 23–96) who presented within 12 hours of symptom onset between January 1, 2002 and June 30, 2008. Using a precise cardiac catheterization protocol, PPCI was the choice reperfusion strategy for all patients. In this cohort, we evaluated outcomes of all patients ≥80 years of age for in-hospital survival, major adverse cardiovascular events (MACE) and 1-year mortality.
RESULTS: Over a period of 6 years, we identified 91 octogenarians (62% women, median age 83 years). Median duration of hospitalization was four days. Technical success rate was 100%. Overall, the frequency of in-hospital death, cardiovascular death, and MACE (composite of recurrent myocardial infarction, post-PPCI cardiogenic shock, heart failure and stroke) were 5.5%, 4.4% and 20.9%, respectively, compared with 5%, 4% and 12.6% in patients <80 years (table⇓). One-year mortality was particularly high in the octogenerians (24.2%) compared with those <80 years (8%; p<0.001).
CONCLUSION: Our study demonstrates that, although PPCI in contemporary practice may be performed with high technical success in octogenarians, MACE remain higher in this population group. Advanced age and higher burden of pre-existing cardiovascular disease alone may not contribute to this outcome, but may be due in part to physician inertia, as evidenced by a higher door-to-balloon time.