title: Reperfusion strategies and quality of care in 5339 patients age 80 years or older presenting with ST-elevation myocardial infarction: analysis from get with the guidelines-coronary artery disease.
abstract: BACKGROUND
  Data regarding reperfusion strategies, adherence to national guidelines, and in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients age ≥80 years are limited. The aim of this study was to determine current reperfusion trends, medical treatment, and in-hospital mortality during STEMI in older adults.
  
  
  OBJECTIVE
  Among patients aged 80 or above presenting with STEMI, adherence to guidelines, length of stay, and in-hospital mortality would be better in those receiving reperfusion versus those who did not.
  
  
  METHODS
  Using the Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) database, we examined care and in-hospital outcomes of STEMI patients ≥80 years old. Use of evidence-based therapies and quality measures were analyzed by reperfusion strategies.
  
  
  RESULTS
  A total of 5339 patients age ≥80 years hospitalized with STEMI were included. Of these, 42.8% (n = 2285) underwent primary percutaneous coronary intervention (PPCI), 4.8% (n = 255) underwent thrombolysis (TL), and 52.4% (n = 2799) received no reperfusion (NR). Patients with NR were more likely to be older, female, have lower body mass index, and higher prevalence of renal insufficiency and heart failure compared with PPCI or TL patients. During the last decade, there was a significant increase in the use of PPCI compared with TL as the main reperfusion strategy in this population. Adjusted in-hospital mortality in PPCI patients was lower compared with NR patients (odds ratio [OR]: 0.41, 95% confidence interval [CI]: 0.35-0.49); also, patients undergoing PPCI or TL had lower mortality compared with NR patients (OR: 0.47, 95% CI: 0.40-0.55).
  
  
  CONCLUSIONS
  Among patients ≥80 years old admitted with STEMI to GWTG-CAD hospitals, less than half undergo mechanical or pharmacological reperfusion. However, the proportion of patients undergoing PPCI has increased substantially over the 8-year study period. Patients undergoing PPCI or TL had lower in-hospital mortality compared with the NR strategy.
authors: Department of Medicine, Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA.
authors: Hector M
authors: HM
authors: Medina
authors: Christopher P
authors: CP
authors: Cannon
authors: Gregg C
authors: GC
authors: Fonarow
authors: Maria V
authors: MV
authors: Grau-Sepulveda
authors: Adrian F
authors: AF
authors: Hernandez
authors: W
authors: W
authors: Frank Peacock
authors: Warren
authors: W
authors: Laskey
authors: Eric D
authors: ED
authors: Peterson
authors: Lee
authors: L
authors: Schwamm
authors: Deepak L
authors: DL
authors: Bhatt
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012042:Registries; D015912:Thrombolytic Therapy / Q000379:methods
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors