Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty
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Key result
Increasing age was an independent predictor of 30-day mortality (HR 1.049 per 1-year increase) and was associated with longer delays to reperfusion, less aggressive treatment, and higher rates of PCI complications in STEMI patients.
Population
1,650 consecutive STEMI patients transferred for primary PCI from 15 hospital networks in 7 European…
Design
Cohort
Follow-up
30 days and 1 year
Authors
Discussion
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Implication
Age-related STEMI care gaps persist and drive mortality; hypothesis-generating for equity-focused interventions pending prospective trials.
Study Design
Type
Observational (n=1,650)
Multicenter
Yes
Structured PICO
P
Population
1,650 consecutive STEMI patients transferred for primary PCI across 15 hospital networks in 7 European countries, followed for up to 1 year to assess age-related differences in treatment and outcomes.
O
Outcome
All-cause death, reinfarction, urgent revascularization (PCI or coronary artery bypass grafting), and bleeding complications (puncture site hematoma, intracranial hemorrhage, major bleeding requiring transfusion) at 30-day follow-uphard clinical
Main Result
Hazard Ratio: 1.049 (95% CI 1.026–1.072)
p-value: p=<0.0001
Limitations
- Relatively small study group, with the very elderly subset (≥85 years) comprising only 3% of the population
- Focused mainly on 30-day clinical outcomes
- Patients were not screened for contraindications to medications and dosage appropriateness was not assessed
- Conducted between 2005 and 2007, before newer P2Y12 inhibitors were available
- Low frequency of bivalirudin monotherapy
- TIMI flow and ST-resolution were assessed by physicians rather than an independent core-lab
- Relatively small study group, especially the ≥85 years subset which comprised only 3% of the population
- Patients were not screened for contraindications to medications and appropriateness of dosage was not assessed
- Conducted between 2005 and 2007, before newer P2Y12 inhibitors (prasugrel, ticagrelor) and bivalirudin were widely used
Cite This Study
Dziewierz et al. (2012) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=1,650). Advanced age vs. Younger age was evaluated on 30-day mortality (HR 1.049, 95% CI 1.026-1.072, p=<0.0001). Increasing age was an independent predictor of 30-day mortality (HR 1.049 per 1-year increase) and was associated with longer delays to reperfusion, less aggressive treatment, and higher rates of PCI complications in STEMI patients.
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