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Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST‐segment elevation myocardial infarction: From the Western Denmark heart registry
Author(s) -
Antonsen Lisbeth,
Jensen Lisette Okkels,
Terkelsen Christian Juhl,
Tilsted HansHenrik,
Junker Anders,
Maeng Michael,
Hansen Knud Noerregaard,
Lassen Jens Flensted,
Thuesen Leif,
Thayssen Per
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24591
Subject(s) - medicine , percutaneous coronary intervention , hazard ratio , myocardial infarction , cardiology , confidence interval , proportional hazards model , population , environmental health
Background Elderly patients with ST segment elevation myocardial infarction (STEMI) constitute a particular risk group in relation to primary percutaneous coronary intervention (PPCI). Objective We examined the proportion of octogenarians and nonagenarians undergoing PPCI in Western Denmark, and their short‐ and long‐term mortality rates. Methods From 2002 to 2009 all consecutive patients ≥80 years with STEMI treated with PPCI were identified in the population based Western Denmark Heart Registry. Cox regression analysis was used to compute hazard ratios, controlling for potential confounding. Results A total of 1,322 elderly (1,213 octogenarians and 109 nonagenarians), corresponding to 11.6% of the total PPCI treated STEMI population were treated with PPCI between 2002 and 2009. The annual proportion of octogenarians referred for PPCI increased from n = 52 (6.2%) in 2002 to n = 172 (11.8%) in 2009 ( P < 0.01), while it remained unchanged in nonagenarians: n = 6 (0.6%) in 2002 to n = 13 (0.8%) in 2009 ( P = ns). For octogenarians and nonagenarians, 30‐day mortality was 17.2% versus 25.8% (log‐rank P = 0.028), 1‐year mortality was 27.6% versus 32.5% (log‐rank P = 0.18) and 5‐year mortality 53.6% versus 57.3% (log‐rank P = 0.087), respectively. Adjusted 30‐day hazard ratio (HR) = 1.59 (95% confidence interval = CI: 1.07–2.36), 1‐year HR = 1.34 (CI: 0.95–1.90), and 5‐year mortality HR = 1.39 (CI: 1.04–1.85) was higher in nonagenarians compared with octogenarians. Conclusion The annual proportion of octogenarians with STEMI treated with PPCI doubled from 2002 to 2009, while the proportion of nonagenarians remained unchanged. Although nonagenarians had the highest short‐ and long‐term mortality, we found the outcome acceptable with a 5‐year survival of more than 40% in both groups. © 2013 Wiley Periodicals, Inc.