Key result
Nonagenarian patients with acute myocardial infarction had a similar 1-year rate of major adverse cardiac events compared to octogenarians (24.6% vs 22.2%, adjusted HR 1.25), despite higher in-hospital mortality.
Why the study?
Does percutaneous coronary intervention (PCI) improve 1-year clinical outcomes in nonagenarian and octogenarian patients with acute myocardial infarction, and how do outcomes compare between these age groups?
Cohort (n=2,415)
Yes
Does percutaneous coronary intervention (PCI) improve 1-year clinical outcomes in nonagenarian and octogenarian patients with acute myocardial infarction, and how do outcomes compare between these age groups?
Hazard Ratio: 1.25 (95% CI 0.62–2.51)
Absolute Event Rate: 24.6% vs 22.2%
p-value: p=0.528
In very elderly patients with acute myocardial infarction, nonagenarians have similar 1-year MACE rates to octogenarians, and percutaneous coronary intervention is associated with significantly improved 1-year clinical outcomes in both age groups.
Similar 1-year MACE in nonagenarians versus octogenarians after AMI; leaves open whether PCI improves outcomes in these elderly cohorts.
We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3 ± 2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.
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Lee et al. (2014) conducted a cohort in Acute Myocardial Infarction (n=2,415). Nonagenarian age (≥90 years) vs. Octogenarian age (80-89 years) was evaluated on 1-year major adverse cardiac events (composite of all-cause death, MI, and repeated PCI or CABG) (HR 1.25, 95% CI 0.62-2.51, p=0.528). Nonagenarian patients with acute myocardial infarction had a similar 1-year rate of major adverse cardiac events compared to octogenarians (24.6% vs 22.2%, adjusted HR 1.25), despite higher in-hospital mortality.
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