title: Contemporary clinical outcomes of primary percutaneous coronary intervention in elderly versus younger patients presenting with acute ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PPCI) is the choice reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). However, data on PPCI in elderly patients are sparse. This study determined clinical outcome post-PPCI in elderly versus younger patients with STEMI.
  
  
  RESULTS
  A cohort of 790 consecutive STEMI patients was studied for survival and major adverse cardiovascular events (MACE) after PPCI using a precise cardiac catheterization protocol. Patients were divided into two groups: those ≥75 years (elderly) and those <75 years. Median door-to-balloon time (DBT) was 82 minutes in the elderly versus 66 minutes in the younger group (P = 0.002). In-hospital all-cause mortality was higher in the elderly group (15.5% vs. 2.7%, P < 0.001). In elderly patients, MACE were found to be higher (32.3% vs. 16.1%, P < 0.001). Using a multivariate logistic regression analysis, age (odds ratio [OR]= 1.04, 95% confidence interval [CI]= 1.02-1.05, P < 0.001), diabetes (OR = 2.17, 95% CI = 1.33-3.53, P = 0.002), renal failure (OR = 3.75, 95% CI = 1.30-10.79, P = 0.014) and coronary artery disease (OR = 1.61, 95% CI = 1.00-2.59, P = 0.050) were associated with higher in-hospital MACE, while age (OR = 1.05, 95% CI = 1.02-1.08, P = 0.001), diabetes (OR = 2.18, 95% CI = 1.06-4.47, P = 0.034) and renal failure (OR = 6.65, 95% CI = 2.01-22.09, P = 0.002) were associated with higher in-hospital mortality. Kaplan-Meier 1-year survival rate was lower in the elderly.
  
  
  CONCLUSIONS
  In a contemporary population of STEMI patients treated with PPCI, overall in-hospital MACE and mortality remain higher in elderly compared to younger patients. Although partly due to higher burden of preexisting comorbidities, a higher DBT may also be responsible. (J Interven Cardiol 2011;24:357-365).
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, USA.
authors.forename: Abdul Moiz
authors.initials: AM
authors.lastname: Hafiz
authors.forename: Muhammad Fuad
authors.initials: MF
authors.lastname: Jan
authors.forename: Naoyo
authors.initials: N
authors.lastname: Mori
authors.forename: Anjan
authors.initials: A
authors.lastname: Gupta
authors.forename: Tanvir
authors.initials: T
authors.lastname: Bajwa
authors.forename: Suhail
authors.initials: S
authors.lastname: Allaqaband
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome