Age‐related differences in reperfusion therapy and outcomes for ST‐segment elevation myocardial infarction

• Autores: Julien Turk, Magali Fourny, Komlavi Yayehd, Nicolas Picard, François Xavier Ageron, Bastien Boussat, Loïc Belle, Gérald Vanzetto, Etienne Puymirat, Guillaume Debaty, Joël Belmin, Elodie Sellier, Jose Labarere, Helène Thiel, Marie-Antoinette Sevestre, Pascal Couturier
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 7, 2018, págs. 1325-1331
• Idioma: inglés
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• Resumen

  • Objectives To compare timely access to reperfusion therapy and outcomes according to age of older adults with ST‐segment elevation myocardial infarction (STEM) managed within an integrated regional system of care.

    Design Ongoing, prospective, regional, hospital‐based clinical registry.

    Setting Twenty‐three public and private hospitals in the Northern Alps in France.

    Participants Individuals presenting with STEMI evolving for less than 12 hours from symptom onset between January 2009 and December 2015 (N=4,813; 3,716 (77.2%) <75, 782 (16.2%) 75–84, 315 (6.5%) ≥85).

    Measurements Delivery of any reperfusion therapy (primary percutaneous coronary intervention (PCI), intravenous fibrinolysis), primary PCI, and timely reperfusion therapy and in‐hospital outcomes.

    Results The percentages of patients receiving any reperfusion therapy were 92.9% for those younger than 75, 89.0% for those aged 75 to 84, and 78.7% for those aged 85 and older (P < .001). The percentages of patients undergoing primary PCI were 63.7%, 70.3%, 72.4% (P < .001); and the percentages of patients receiving timely delivery of reperfusion therapy were 44.6%, 36.8%, 29.9% (P < .001). In‐hospital all‐cause mortality was 3.4% for those younger than 75, 10.2% for those aged 75 to 84, and 19.8% for those aged 85 and older (P <.001). In multivariable analysis adjusting for baseline characteristics, timely delivery of reperfusion therapy was associated with lower in‐hospital mortality (adjusted odds ratio=0.63, 95% confidence interval=0.46–0.85) with no significant heterogeneity between age groups (P‐value for interaction = .45).

    Conclusion Older adults meeting contemporary eligibility criteria for reperfusion therapy continue to receive delayed reperfusion therapy and experience higher mortality than their younger counterparts.