July 12, 2026The International Journal of Cardiovascular Imaging0 citationsOpen Access
ST-segment elevation myocardial infarction in older adults: echocardiographic characterization and outcomes in contemporary practice
Key Result
Patients aged ≥80 years with STEMI experienced more adverse left ventricular remodeling (29.1% vs 19.2%) and higher five-year mortality (25.8% vs 4.3%) than younger patients.
Key Points
- The study aims to evaluate cardiac remodeling, medication use, and outcomes in older adults following ST-segment elevation myocardial infarction (STEMI).
- Retrospective analysis of STEMI registry data involving 2178 patients, with 132 aged ≥ 80 years.
- Echocardiography assessment at baseline and one year post-infarct.
- Comparison of left ventricular function and medication use between older and younger patients.
- Older patients had a lower baseline left ventricular ejection fraction (47.2% vs. 49.8%; p < 0.001) and a higher rate of adverse LV remodeling (29% vs. 19%; p = 0.024).
- One year post-infarct, older adults were hospitalized for heart failure more frequently (7.0% vs. 2.6%; p = 0.006).
- Five-year mortality was significantly higher in older patients (25.8% vs. 4.3%; p < 0.001).
Study Design
Type
Cohort (n=2,178)
Multicenter
No
Structured PICO
Do older adults (≥ 80 years) with STEMI have worse echocardiographic remodeling and clinical outcomes compared to younger patients?
P
Population
2,178 patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, followed for up to 5 years to compare echocardiographic and clinical outcomes between those aged ≥80 and <80 years.
E
Exposure
Age ≥ 80 years
C
Comparator
Age < 80 years
O
Outcome
Left ventricular remodeling (>20% relative increase in LV end-diastolic volume at 1 year), LV function recovery, medication use, 1-year cardiovascular outcomes, and 5-year all-cause mortalityhard clinical
Older STEMI patients (≥80 years) experience more adverse LV remodeling and higher mortality than younger patients, despite similar LV function recovery, and receive fewer guideline-directed medical therapies.
Main Result
Absolute Event Rate: 29.1% vs 19.2%
p-value: p=0.024
Limitations
- Single-center, retrospective design
- Relatively low number of older patients
- Data on frailty and exact cause of death were not systematically available
- Lack of data on newer medications (SGLT2 inhibitors, ARNIs, PCSK9 inhibitors)
- Higher loss to follow-up echocardiography in the older patient group
Abstract
Abstract Evidence on cardiac remodeling, left ventricular (LV) function recovery, medication use and outcomes in older ST-segment elevation myocardial infarction (STEMI) patients is limited. We examined these aspects at baseline and evolution one year post-infarct in patients aged ≥ 80 versus 20% relative increase in the LV end-diastolic volume. One-year cardiovascular outcomes and five-year all-cause mortality are reported.Study included 2178 patients; 132 (6.1%) were aged ≥ 80. Older patients had worse baseline LV ejection fraction (47.2 ± 9.6% versus 49.8 ± 8.2%; p < 0.001) and experienced more adverse LV remodeling (29% versus 19%; p = 0.024). Nevertheless, LV function improved similarly in both groups. Beta-blocker and renin-angiotensin-aldosterone system inhibitor use was lower (86.4% versus 94.2%; p < 0.001 and 90.2% versus 96.5%; p < 0.001, respectively) but diuretic prescription higher (18.2% versus 8.1%; p < 0.001) in older patients. One year post-infarct beta-blocker and renin-angiotensin-aldosterone system inhibitor use decreased and was similar in both groups, but older patients continued to receive more diuretics and suffered higher heart failure hospitalization rates (7.0% versus 2.6%; p = 0.006). Five-year mortality was 25.8% in older versus 4.3% in younger patients (log-rank χ2 133.2; p < 0.001).Older patients experienced more adverse LV remodeling, received less beta-blockers and renin-angiotensin-aldosterone system inhibitors but more diuretics at discharge and one year, compared to younger patients. Nevertheless, LV function recovered similarly in both groups.
Cite This Study
Caunīte et al. (Sat,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=2,178). Age ≥ 80 years vs. Age < 80 years was evaluated on Adverse left ventricular remodeling at 1 year (>20% relative increase in LV end-diastolic volume) (p=0.024). Patients aged ≥80 years with STEMI experienced more adverse left ventricular remodeling (29.1% vs 19.2%) and higher five-year mortality (25.8% vs 4.3%) than younger patients.