title: ST-elevation myocardial infarction in the elderly--temporal trends in incidence, utilization of percutaneous coronary intervention and outcomes in the United States.
abstract: BACKGROUND
  Elderly patients with ST-elevation myocardial infarction (STEMI) are often underrepresented in major percutaneous coronary intervention (PCI) trials. Use of PCI for STEMI, and associated outcomes in patients aged ≥65 years with STEMI needed further investigation.
  
  
  METHODS
  We used the 2001-2010 United States Nationwide Inpatient Sample (NIS) database to examine the temporal trends in STEMI, use of PCI for STEMI, and outcomes among patients aged 65-79 and ≥80 years.
  
  
  RESULTS
  During 2001-2010, of 4,017,367 patients aged ≥65 years with acute myocardial infarction (AMI), 1,434,579 (35.7%) had STEMI. Over this period, among patients aged 65-79 and ≥80 years, STEMI decreased by 16.4% and 19%, whereas the use of PCI for STEMI increased by 33.5% and 22%, respectively (Ptrend<0.001). There was a significant decrease in age-adjusted in-hospital mortality (per 1000) in patients aged ≥80 years (150 versus 116, Ptrend=0.02) but not in patients aged 65-79 years (63 versus 59, Ptrend=0.886). Stepwise logistic regression identified intra-aortic balloon pump use, acute renal failure, acute cerebrovascular disease, age ≥80 years, peripheral vascular disease, gastrointestinal bleeding, female gender, congestive heart failure, chronic lung disease, weekend admission and multivessel PCI as independent predictors of in-hospital mortality among all patients ≥65 years of age who underwent PCI for STEMI.
  
  
  CONCLUSIONS
  In this large, multi-institutional cohort of elderly patients, a decreasing trend in STEMI, an increasing trend in PCI utilization for STEMI, and reduction in in-hospital mortality were observed from 2001 to 2010.
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY, USA. Electronic address: sahil_khera@nymc.edu.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Tarunjit
authors.initials: T
authors.lastname: Singh
authors.forename: William
authors.initials: W
authors.lastname: Gotsis
authors.forename: Gary
authors.initials: G
authors.lastname: Silverman
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data* / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Elderly; In-hospital mortality; Percutaneous coronary intervention; ST-elevation myocardial infarction; Trends