Abstract 16160: Percutaneous Coronary Intervention for Acute Myocardial Infarction in the Elderly: A Study of the National Inpatient Sample 2001-2009

Abstract

Background: Percutaneous Coronary Intervention (PCI) has is the primary means of revascularization for acute myocardial infarction (AMI) in the United States. We sought to examine trends in PCI for AMI amongst octogenarians in the United States from 2001-2009.

Methods: Using the National Inpatient Sample years 2001-2009 we selected all patients ≥80 years old with a primary diagnosis of AMI (STEMI or NSTEMI). We determined trends in the proportion of these patients receiving PCI for NSTEMI and STEMI and trends in the use of drug eluting stents (DES). Outcomes studied included length of stay and in-hospital mortality.

Results: 840020 patients ≥80 years old had a primary diagnosis of AMI between 2001-2009 (296934 STEMI and 543086 NSTEMI patients). 17.1% of STEMI patients had PCI compared to 10.4% of NSTEMI patients (P<.0001). 11.4% of STEMI patients underwent PCI in 2001 compared to 28.9% in 2009 (P<.0001). 7.8% of NSTEMI patients underwent PCI in 2001 compared to 10.9% in 2009 (P<.0001) (Figure 1). Trends in utilization of DES are available in Figure 2. In-hospital mortality amongst STEMI patients receiving PCI was 13.9% and 4.0% for NSTEMI patients. Mean length of stay was 5.8±11.3 days for STEMI patients with PCI and 5.4±10.2 days for NSTEMI patients.

Conclusions: Since 2001, the proportion of octogenarians receiving PCI for AMI has increased significantly. In-hospital mortality amongst these patients is low. Utilization rates of DES peaked in 2005 but has since experienced a significant downward trend. Given the increased utilization of this costly intervention amongst octogenarians, more must be done to study predictors of poor outcomes to ensure proper selection of PCI candidates.