title: Procedural and in-patient outcomes in patients aged 80 years or older undergoing contemporary primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Patients aged ≥80 years are often excluded or under-represented in trials assessing treatment modalities in STEMI. We assessed in-patient outcomes in elderly patients undergoing contemporary primary PCI (PPCI).
  
  
  RESULTS
  From Sept 2005 to July 2011 patients undergoing PPCI in our centre were identified. Demographic details, procedural data and in-patient outcomes were collated. Those aged ≥80 years were compared with those aged <80 years. In the study period 1,218 patients required PPCI, of which 224(18.4%) were ≥80 years. The elderly cohort were more likely to be female (44.3% vs. 20.3%; p<0.001), and have significant comorbidities. Times from first medical contact until TIMI 3 flow were similar between the two groups (medien 102 min vs. 109 min; p=0.19). There was no difference in rates of PCI success (97.3% vs. 98.3%; p=0.24), drug-eluting stent use (63.5% vs. 63.3%; p=1.00) and number of stents used. In-patient outcomes were worse in the elderly cohort with significantly higher rates of death (11.2% vs. 3.7%; p<0.001) and acute kidney injury (12.9% vs. 4.0%; p<0.001), with a trend towards more post-procedure cardiovascular accidents (CVA), access site complications and reinfarction. Length of stay was significantly longer in the elderly cohort (median days 5 vs. 3; p<0.001).
  
  
  CONCLUSIONS
  Important demographic differences exist in very elderly patients presenting with STEMI compared to younger patients though procedural data and PCI success rates are similar between the two groups. Those aged ≥80 years have significantly worse in-patient outcomes though death rates are not as high as historical data suggests.
authors.affiliation: Dept of Cardiology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Sydney, Australia. conleth_m@hotmail.com
authors.forename: John C
authors.initials: JC
authors.lastname: Murphy
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Kozor
authors.forename: Gemma
authors.initials: G
authors.lastname: Figtree
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hansen
authors.forename: Helge H
authors.initials: HH
authors.lastname: Rasmussen
authors.forename: Michael R
authors.initials: MR
authors.lastname: Ward
authors.forename: Gregory I C
authors.initials: GI
authors.lastname: Nelson
authors.forename: Ravinay
authors.initials: R
authors.lastname: Bhindi
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology*; D015996:Survival Rate; D016896:Treatment Outcome