title: Reperfusion therapy and mortality in octogenarian STEMI patients: results from the Belgian STEMI registry.
abstract: BACKGROUND
  Treatment strategies and outcome of ST-elevation myocardial infarction (STEMI) have been mainly studied in middle-aged patients. With increasing lifetime expectancy, the proportion of octogenarians will substantially increase. We aimed to evaluate whether the benefit of currently recommended reperfusion strategies is maintained in octogenarians.
  
  
  METHODS
  Reperfusion therapy and in-hospital mortality were evaluated in 1,092 octogenarians and compared with 7,984 STEMI patients <80 years old based on data from the prospective Belgian STEMI registry.
  
  
  RESULTS
  The octogenarian STEMI group had more cardiovascular comorbidities, contained more female patients and presented more frequently with cardiac failure (Killip class >1, 40 vs. 20 %) compared with their younger counterparts (all p < 0.05). Although the rate of thrombolysis was similar (9.2 vs. 9.9 %) between both groups, a conservative approach was chosen more frequently (13.8 vs. 4.7 %), while PCI was performed less frequently (76.9 vs. 85.4 %) in octogenarians (p < 0.001). Moreover, ischemic time and door-to-needle/balloon time were longer for octogenarians. In-hospital mortality for octogenarians was 17.8 vs. 5.5 % in the younger group [adjusted OR 2.43(1.92-3.08)]. In haemodynamically stable octogenarians, PCI seemed to improve outcome compared with thrombolysis or conservative treatment (5.7 vs. 12.7 vs. 8.5 %, p = 0.09). In octogenarians with cardiac failure, in-hospital mortality was extremely high independent of the chosen reperfusion therapy (34.6 vs. 31.6 vs. 36.3 %, p = 0.88).
  
  
  CONCLUSIONS
  In-hospital mortality in octogenarian STEMI patients was high and related to a high prevalence of cardiac failure. Less PCI was performed in the octogenarian group compared with the younger patients, although mortality benefit of PCI was maintained in haemodynamically stable octogenarians.
authors.affiliation: Department of Cardiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium, els.vandecasteele@ugent.be.
authors.forename: Els H
authors.initials: EH
authors.lastname: Vandecasteele
authors.forename: Marc
authors.initials: M
authors.lastname: De Buyzere
authors.forename: Sofie
authors.initials: S
authors.lastname: Gevaert
authors.forename: Antoine
authors.initials: A
authors.lastname: de Meester
authors.forename: Carl
authors.initials: C
authors.lastname: Convens
authors.forename: Philippe
authors.initials: P
authors.lastname: Dubois
authors.forename: Jean
authors.initials: J
authors.lastname: Boland
authors.forename: Peter
authors.initials: P
authors.lastname: Sinnaeve
authors.forename: Herbert
authors.initials: H
authors.lastname: De Raedt
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.forename: Patrick
authors.initials: P
authors.lastname: Coussement
authors.forename: Patrick
authors.initials: P
authors.lastname: Evrard
authors.forename: Christophe
authors.initials: C
authors.lastname: Beauloye
authors.forename: Marc
authors.initials: M
authors.lastname: Renard
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Claeys
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001530:Belgium; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome