Revascularization algorithm in acute STEMI should take into account age☆

Abstract 

Background

In the elderly patients, the optimal reperfusion strategy of acute ST-segment elevation myocardial infarction (STEMI) remains a topic of debate. Moreover, there is a lack of data regarding the effect of time to treatment (TT) on prognosis of STEMI in elderly patients.

Purpose

The goal of our work was to analyze, in real life, the link between TT and 1-year mortality in patients with STEMI (≥75 years) who were treated with thrombolysis (THL) or primary percutaneous coronary intervention (PCI).

Methods and materials

Data were extracted from our university hospital prospective registry. Between 1995 and 2005, all patients who met the criteria (≥75 years old, has had an acute STEMI <12 h, has been admitted directly into our cardiologic care unit, and has had a revascularization procedure) were included in the analysis. Using logistic regression, we studied the relation between TT and 1-year mortality for each strategy of reperfusion in patients with STEMI who were ≥75 years old.

Results

One hundred fifty-nine consecutive patients with STEMI <12 h were analyzed; 35 were treated with THL and 124 were treated with primary PCI. Mean age (±S.D.) was 80±4 years, and 56% of patients were men. In logistic regression analysis, TT was not associated to death after THL (P=.81), while it was positively correlated after PCI (P=.03). All-cause 1-year mortality was markedly higher in the THL group than in the PCI group (51.4% vs. 15.3%; P<.001).

Conclusion

Our work suggests that the extrapolation of algorithm of revascularization used in younger patients is not appropriate for elderly patients. Specific algorithm of revascularization and recommendations are needed in elderly patients.

Keywords: Acute STEMI, Time to treatment, Elderly, Revascularization, One-year mortality