Primary Coronary Intervention in Octogenarians with ST-Segment Elevation Myocardial Infarction

Introduction:

The proportion of individuals >80 years of age constitute a growing fraction of patients who present with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding outcomes in these patients.

Objectives:

To evaluate 1-month and 1-year outcomes of octogenarian patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI).

Methods: The study included 601 consecutive STEMI patients from the Rabin Medical Center prospective registry. There were 198 patients over the age of 80 and 403 aged 70-79 years. Outcomes are reported for 1 month and 1 year.

Results:

Mean age was 85±3.8 in the octogenarian group and 74±2.9 in the control group. More patients over 80 were female (44% vs. 33%, p<0.01), more had hypertension (79% vs. 66%, p<0.01) and renal failure (43% vs. 23%, p<0.01). During presentation, more octogenarians suffered from multi-vessel disease (76% vs. 65%, p<0.0) and calcified lesions (35% vs. 26%, p=0.02).

Both at 1 month and at 1 year, rates of death were higher for the octogenarians (9.6 vs. 4.7%, p=0.02 and 15.7% vs. 9.7%, p=0.03, respectively), but other outcomes, including recurrent infarction, stent thrombosis, target vessel revascularization and the sum of major adverse cardiac events were not different between the two groups.

Conclusion:

Patients over the age of 80 have similar benefit from pPCI during STEMI, albeit a higher short-term rate of death.