Clinical InvestigationAcute Ischemic Heart DiseaseImpact of age on treatment and outcomes in ST-elevation myocardial infarction
Section snippets
Minneapolis Heart Institute Level 1 MI program
Details and outcomes of the Minneapolis Heart Institute Level 1 STEMI Program have been previously published.15, 23 After an initial pilot period in early 2003, a regional STEMI program using a standardized protocol was developed for transfer of STEMI patients for primary PCI. Patients presenting to community hospitals within 60 miles of Abbott Northwestern Hospital (Zone 1) receive aspirin, β-blocker, heparin (unfractionated heparin is used per protocol, whereas <1% of patients were already on
Results
We identified 2,262 patients who were treated for STEMI during a 5-year interval (March 2003 through December 2008). The distribution of patients was weighted to younger individuals: age greater than 65 years (n = 1,285; range, 17-64 years), age 65 to 74 years (n = 436), age 75 to 84 years (n = 381), age 85 years or greater (n = 160; range, 85-99 years). However, 24% (n = 541) of patients were 75 years or older.
Demographic, baseline clinical, and angiographic factors varied by age stratum (
Discussion
There are limited data regarding MI outcomes in older patients, particularly in the setting of PCI for STEMI. Numerous randomized clinical trials have compared a strategy of PCI to fibrinolysis for patients with STEMI, but older patients have been excluded from most of these trials.9 Three relatively small randomized clinical trials appear to support PCI over fibrinolysis, but the results are inconclusive.16, 17, 18 Observational registries also suggest a benefit of PCI over fibrinolysis in
Disclosures
Grant support: Minneapolis Heart Institute Foundation.
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2023, Biochemical and Biophysical Research CommunicationsCoronary Artery Aneurysms in ST-Elevation Myocardial Infarction (From a United States Based National Cohort)
2022, American Journal of CardiologyCitation Excerpt :The patients with CAA were younger and more likely to be male. Younger age and male gender have a favorable prognosis in STEMI.29–31 A lower mortality has been previously reported for SCAD in a cohort of patients with myocardial infarction.32
Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention
2017, International Journal of CardiologyCitation Excerpt :Renal function and anterior myocardial infarction were significantly and independently correlated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular diseases at the multivariate analysis. On the basis of our data and other studies [6,21,22,25–27,33,37], older STEMI patients can receive similar care to younger patients. A PCI-based strategy is preferred in elderly patients with STEMI and rapid transfer for pPCI (in combination with appropriate adjunctive pharmacology) produced improved outcomes, although still worse than in younger patients.
The challenge of caring for myocardial infarction in the elderly
2015, Revista Clinica EspanolaOutcomes of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with previous coronary bypass surgery
2014, JACC: Cardiovascular Interventions