title: Temporal trends in the use of reperfusion therapy and outcomes in elderly patients with first ST elevation myocardial infarction.
abstract: OBJECTIVE
  To analyze secular trends in management and short and long-term prognosis of elderly presenting with ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  All patients ≥ 75 years with first STEMI admitted to our Coronary Care Unit between 1988 and 2008 were included. Baseline characteristics, clinical management, in-hospital and post-discharge outcomes in 4 time periods (1988-1993, 1994-1998, 1999-2003, 2004-2008) were compared. The final cohort consisted of 1393 patients. During the study period, there was a significant increase in the use of aspirin, β-blockers and ACE inhibitors. A significant reduction in the development of cardiogenic shock and mechanical complications was noticed. The use of reperfusion therapy increased significantly, due to a wider use of primary percutaneous coronary intervention (PPCI) while 30-days, 1-year and 5-year mortality decreased throughout the 20-year study period (p<0.001). In the multivariable logistic regression model, patients treated with PPCI showed a significantly lower 30-day (OR 0.47, 95% CI, 0.31-0.71), 1-year (OR 0.62, 95% CI 0.43-0.88) and 5-year mortality (OR 0.57, 95% CI 0.41-0.79) while patients receiving fibrinolysis showed a non-significant improvement in 30-day (OR 0.86, 95% CI 0.62-1.49), 1-year (OR 0.86, 95% CI 0.58-1.30) and 5-year mortality (OR 0.82, 95% CI 0.56-1.19).
  
  
  CONCLUSIONS
  The use of reperfusion therapy, and particularly of PPCI, for elderly patients suffering from STEMI increased significantly during the study period. This change in therapy was associated with a marked improvement in short and long-term prognosis.
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Spain ana_viana_tejedor@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Viana-Tejedor
authors.affiliation: Hospital General Universitario Gregorio Marañón, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Loughlin
authors.affiliation: Hospital General Universitario Gregorio Marañón, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Hospital General Universitario Gregorio Marañón, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003325:Coronary Care Units; D005260:Female; D005342:Fibrinolysis; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D009026:Mortality; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods* / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: ST-elevation myocardial infarction; elderly; outcomes; reperfusion therapy