Impact of reperfusion strategy on outcomes in very elderly patients with acute myocardial infarction.

AIM

The best reperfusion strategy for patients of advanced age (either primary-angioplasty or thrombolysis) after a ST-segment elevation myocardial infarction (STEMI) remains controversial. Aim of the study was to test differences in morbidity and mortality regarding the reperfusion strategy adopted.

METHODS

From 2007-2012, 182 patients ≥85 year-old with STEMI were admitted to the coronary care unit of two tertiary centers. Data regarding baseline characteristics, clinical presentation, reperfusion strategy adopted and outcomes were retrospectively reviewed. The relation between the type of reperfusion therapy and outcomes was evaluated.

RESULTS

Median age was 86.8±6.9 years (range 85-96). Most patients (54.4%) were woman. Anterior wall STEMI was the main electrocardiographic location (45.1%). A conservative treatment was seen in 64 patients (35.2%), thrombolysis in 41 (22.5%) and primary-angioplasty in the remaining 77 patients (42.3%). A total of 56 patients died (30.8%). The mortality rate in the thrombolysis group (21.9%) was similar than that found in the primary-angioplasty group (15.6%) (P=0.45). No difference was found in a subgroup analysis of high risk patients (i.e. anterior wall STEMI, Killip class ≥2). Morbidity rates were also similar between both therapeutic groups (thrombolisys 58.5% vs. primary-angioplasty 46.7%, P=0.22). Morbidity and mortality rates were much higher among those patients treated conservatively than that found in patients who received any of the reperfusion strategies (54.6% vs. 17.8%, P<0.0001 and 79.7% vs. 50.8%, P<0.0001, respectively).

CONCLUSIONS

Mortality and morbidity among very elderly patients with STEMI are extremely high. No differences were found between primary-angioplasty and fibrinolysis with regard to outcomes. A conservative treatment was associated with a worse prognosis.