title: Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: from the Western Denmark heart registry.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark. dr_lissie@hotmail.com
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Antonsen
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.forename: Anders
authors.initials: A
authors.lastname: Junker
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
authors.forename: Knud Noerregaard
authors.initials: KN
authors.lastname: Hansen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003718:Denmark; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome