Abstract 11142: National Outcomes Following Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction in Patients Aged 75 and Above
Introduction: While over 1 in 4 patients presenting with ST-elevation myocardial infarctions (STEMI) in the United States is 75 years or older, considerable uncertainty exists regarding whether reperfusion therapy improves outcomes. The objective of this study was to examine contemporary trends in the use of and outcomes following reperfusion therapy for STEMI in patients aged >75.
Methods: This study was a retrospective observational study of 178,976 patients >75 presenting between 2006-2010 with STEMI using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), a nationally representative 20% stratified sample of inpatient admissions from approximately 1,000 acute care hospitals maintained by the Agency for Healthcare Research and Quality.
Results: Percutaneous coronary intervention (PCI) (52%) and medical management (46%) were the predominant treatment strategies used in the USA between 2006-2010. Unadjusted mortality was 10% and 25% for PCI and medical management, respectively (p<0.001), and complication rates were comparable (23% vs. 24%). Notably, patients receiving PCI were more likely to be discharged home (74% vs. 41%; p<0.001) than patients receiving conservative medical management. PCI was significantly associated with decreased mortality, even after propensity-score matched analysis (OR 0.29, 95% CI 0.27-0.31; p<0.001) and instrumental variable analysis (OR 0.24, 95% CI 0.24-0.25; p 75 presenting with STEMI was significantly associated with shock, PCI therapy, and CABG and not with age or comorbidity.
Conclusions: PCI was associated with a large reduction in mortality in patients 75 and older presenting with STEMI when compared with conservative medical management. Notably, neither age nor comorbidities were major determinants of mortality or complications. Importantly, patients receiving PCI were much more likely to be discharged home than patients receiving conservative medical management.
Author Disclosures: A. Mandawat: None. A. Mandawat: None. R. Mandawat: None. M.K. Mandawat: None.
- © 2014 by American Heart Association, Inc.