Coronary artery diseaseComparison of Outcomes in Patients Aged <75, 75 to 84, and ≥85 Years With ST-Elevation Myocardial Infarction (from the ACTION Registry-GWTG)
Section snippets
Methods
The ACTION-GWTG is part of the National Cardiovascular Data Registry and was created to evaluate and improve the quality of MI care.15 Participating ACTION-GWTG hospitals enroll consecutive patients with a primary diagnosis of STEMI or non-STEMI. At most hospitals, patients are retrospectively identified and are deemed ineligible if admitted for conditions unrelated to MI. In all instances, patient care decisions are the responsibility of the treating physicians. Criteria for patients with
Results
Of the 30,188 patients with STEMI selected, 79.7% (24,070) were <75 years old, 14.2% (4,273) were 75 to 84 years old, and 6.1% (1,845) were ≥85 years old (e.g., the oldest old). The oldest-old patients were mostly women, were not recent smokers, and had less diabetes mellitus and hyperlipidemia. This group had higher prevalence of end-organ co-morbidity (previous heart failure and stroke; Table 1). They also had lower creatinine clearance and higher B-type natriuretic peptide levels than the
Discussion
The oldest-old population comprises about 6% of the STEMI population. This special group has a fourfold higher in-hospital mortality compared to younger patients, a hazard that persists after adjustment and irrespective of reperfusion status. Our data further demonstrate that 42% of the oldest old have contraindications to the reperfusion cited, with patient preference being the primary factor determining this designation. Furthermore, even when the oldest old are deemed eligible for
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2021, American Journal of MedicineCitation Excerpt :No previous study has provided such a comprehensive evaluation of the oldest-old population with myocardial infarction, particularly in regards to several age-related conditions and functional impairments. The sparse literature that focuses on the oldest-old includes studies that are either claims based,5,6 retrospective,3,7 or focused on none or only some of these functional measures.4,8,30,31 Understanding the heterogeneity in presentation, treatment, and outcomes after myocardial infarction necessitates examining a wide range of these health indicators in this vulnerable population.
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2019, International Journal of CardiologyTrends and Impact of Door-to-Balloon Time on Clinical Outcomes in Patients Aged <75, 75 to 84, and ≥85 Years With ST-Elevation Myocardial Infarction
2017, American Journal of CardiologyCitation Excerpt :They also have higher rates of cognitive and functional impairment.14 Consequently, a decision on whether to undertake primary PCI is more complicated and most likely explains the lower rates of reperfusion in elderly patients with STEMI.7,14 In our selected cohort of patients who underwent primary PCI, procedural success was statistically lower in the elderly (93.4%) and very elderly (94.6%).
The ACTION Registry-GWTG is a program of the National Cardiovascular Data Registry with support from the American College of Cardiology and the American Heart Association that receives funding by the Schering-Plough Corporation, Whitehouse Station, New Jersey, and Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership, New York, New York.