Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: A prospective cohort study.
OBJECTIVE
We aimed to study in-hospital mortality and long-term survival in elderly compared to younger patients with ST-segment elevation myocardial infarction (STEMI) in the era of primary angioplasty.


RESULTS
This was a prospective cohort study. All consecutive STEMI-patients admitted to our hospital between September 2005-December 2011 were included in a local registry. Predefined variables were registered during hospital admission. Vital status was obtained from the Norwegian Cause of Death Registry with censoring date 31 December 2011. Adjusted effects of age ⩾80 years on in-hospital- and long-term mortality were determined using propensity score analysis. Of 4525 registered STEMI patients, 600 (13%) were octogenarians or older. In-hospital mortality was 17% in patients ⩾80 years and 4% in patients <80 years. In invasively treated patients (83% of patients ⩾80 years; 98% of patients <80 years), in-hospital mortality was 13% and 3.4%, respectively. Median follow-up time was 2.5 years. Three-year cumulative survival was 52% in patients ⩾80 years vs 89% in patients <80 years. In invasively treated patients ⩾80 years, three-year survival was 58%. The adjusted odds ratio of in-hospital mortality was 2.61 (1.94-3.52) and adjusted incidence rate ratio of long-term mortality was 4.07 (3.43-4.84) in very elderly compared to younger patients.


CONCLUSIONS
Short-term prognosis was acceptable in very elderly STEMI patients, especially in the invasively treated subgroup. However, only 52% of STEMI patients ⩾80 years were alive after three years of follow-up. Very elderly patients had 2.6 times higher risk of in-hospital mortality and 4.1 times the risk of not surviving during long-term follow-up compared to patients <80 years, after adjustment for confounding factors and selection bias.
Department of Cardiology, Oslo University Hospital Ulleval, Norway University of Oslo, Norway.
Kristin M
KM
Kvakkestad
Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Norway.
Michael
M
Abdelnoor
Department of Cardiology, Oslo University Hospital Ulleval, Norway University of Oslo, Norway.
Peter A
PA
Claussen
Department of Cardiology, Oslo University Hospital Ulleval, Norway.
Jan
J
Eritsland
Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway.
Eigil
E
Fossum
Department of Cardiology, Oslo University Hospital Ulleval, Norway University of Oslo, Norway sigrun.h@online.no.
Sigrun
S
Halvorsen
D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008875:Middle Aged; D009664:Norway; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis
ST-elevation myocardial infarction; coronary angiography; long-term survival; octogenarians; primary percutaneous coronary intervention; very elderly