Key result
Elderly patients aged 75 years and older presenting with STEMI had a significantly higher in-hospital mortality rate compared to younger patients (11.3% vs 2.59%, p<0.001).
Why the study?
Does age ≥75 years affect in-hospital mortality and revascularization rates in patients presenting with STEMI?
Cohort (n=975)
No
Does age ≥75 years affect in-hospital mortality and revascularization rates in patients presenting with STEMI?
Absolute Event Rate: 11.3% vs 2.59%
p-value: p=<0.001
Elderly patients with STEMI have higher in-hospital mortality and are less likely to undergo primary PCI compared to younger patients, despite similar rates of guideline-directed medical therapy.
Higher STEMI mortality at age ≥75 warrants targeted risk assessment; leaves open whether closing PCI gaps improves survival in this observational cohort.
V souÄasnĂŠ dobÄ se stĂĄle zvyĹĄuje incidence infarktu myokardu s elevacemi Ăşseku ST (STEMI) u starĹĄĂch osob. V nejnovÄjĹĄĂch guidelines se doporuÄuje okamĹžitĂŠ invazivnĂ vyĹĄetĹenĂ a pĹĂpadnĂĄ primĂĄrnĂ perkutĂĄnnĂ koronĂĄrnĂ intervence (PCI) u vĹĄech pacientĹŻ bez ohledu na vÄk. Podle literĂĄrnĂch ĂşdajĹŻ se vĹĄak intervenÄnĂ lĂŠÄba starĹĄĂch pacientĹŻ se STEMI neprovĂĄdĂ v dostateÄnĂŠ mĂĹe.CĂlem naĹĄĂ studie bylo posoudit vĂ˝sledky hospitalizace starĹĄĂch pacientĹŻ pro STEMI oproti mladĹĄĂm osobĂĄm z hlediska systematickĂŠ intervenÄnĂ lĂŠÄby. ZajĂmali jsme se rovnÄĹž o nÄkterĂĄ, podle nĂĄs vĂ˝znamnĂĄ specifika lĂŠÄby starĹĄĂch pacientĹŻ se STEMI.Posoudili jsme Ăşdaje 975 po sobÄ nĂĄsledujĂcĂch pacientĹŻ se STEMI pĹijatĂ˝ch do jednoho centra v obdobĂ od ledna 2012 do Äervence 2013; z toho 203 (20,8 %) pacientĹŻ bylo ve vÄku 75 let a vĂce.V porovnĂĄnĂ s mladĹĄĂmi osobami byli starĹĄĂ pacienti vÄtĹĄinou Ĺženy (47,2 % vs. 22,7 %; p < 0,001) s vyĹĄĹĄĂ prevalencĂ hypertenze (78,8 % vs. 65,0 %; p < 0,001), avĹĄak niŞťà prevalencĂ kuĹĂĄctvĂ (13,7 % vs. 48,8 %; p < 0,001) a dyslipidemie (54,7 % vs. 41,3 %; p = 0,03). Ve vÄkovĂŠ kategorii ≥ 75 let jsme zaznamenali vĂce kardiovaskulĂĄrnĂch komorbidit: cĂŠvnĂch mozkovĂ˝ch pĹĂhod (11,8 % vs. 4,1 %; p < 0,001), fibrilacĂ sĂnĂ (23,6 % vs. 53,9 %; p < 0,001) a tÄĹžkĂ˝ch vaskulopatiĂ (6,8 % vs. 1,2 %; p < 0,001). U starĹĄĂch pacientĹŻ byly ÄastÄji pozorovĂĄny znĂĄmky srdeÄnĂho selhĂĄnĂ (Killipova tĹĂda > I: 21,1 % vs. 7,2 %; p < 0,001). U obou skupin byla stanovena podobnĂĄ doba ischemie, 54,1 % vs. 55,1 % s pĹevozem do nemocnice do ĹĄesti hodin.U starĹĄĂ skupiny bylo provedeno mĂŠnÄ PCI (74,3 % vs. 85,7 %; p = 0,02). Rozsah lĂŠzĂ na koronĂĄrnĂch tepnĂĄch se vĂ˝znamnÄ neliĹĄil, aĹž na dva pĹĂpady postiĹženĂ kmene levĂŠ vÄnÄitĂŠ tepny u starĹĄĂch pacientĹŻ (12,2 % vs. 5,1 %; p < 0,001).Mezi obÄma skupinami nebyly vĂ˝znamnĂŠ rozdĂly v lĂŠÄbÄ bÄhem hospitalizace (duĂĄlnĂ antiagregaÄnĂ lĂŠÄba, antikoagulace, beta-blokĂĄtory, inhibitory enzymu konvertujĂcĂho angiotensin [ACE]/blokĂĄtory receptorĹŻ AT1 pro angiotensin II a statiny). NemocniÄnĂ mortalita vĹĄech naĹĄich pacientĹŻ byla 4,41 %, s hodnotami 11,3 % u starĹĄĂ skupiny a 2,59 % ve skupinÄ ve vÄku < 75 let (p < 0,001).VĂ˝sledky lĂŠÄby starĹĄĂch pacientĹŻ se STEMI bÄhem pobytu v nemocnici byly horĹĄĂ, se zvýťenou mortalitou, zvlĂĄĹĄtÄ u osob se srdeÄnĂm selhĂĄnĂm jiĹž pĹi pĹĂjmu. U starĹĄĂch pacientĹŻ bylo provedeno mĂŠnÄ PCI, i kdyĹž ve farmakoterapii nebyl ŞådnĂ˝ rozdĂl zjiĹĄtÄn. U vĹĄech pacientĹŻ bez ohledu na vÄk je nutno uplatĹovat strategii okamĹžitĂŠho koronarografickĂŠho vyĹĄetĹenĂ a v pĹĂpadÄ potĹeby primĂĄrnĂ PCI.
No takes yet. Share an insight, caveat, or question.
Dorobanţu et al. (2014) conducted a cohort in ST segment elevation acute myocardial infarction (STEMI) (n=975). Age ≥ 75 years vs. Age < 75 years was evaluated on In-hospital mortality rate (p=<0.001). Elderly patients aged 75 years and older presenting with STEMI had a significantly higher in-hospital mortality rate compared to younger patients (11.3% vs 2.59%, p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: