title: Long-term ischaemic and bleeding outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction in the elderly.
abstract: BACKGROUND
  The population is ageing rapidly and the proportion of patients aged ≥ 80 years undergoing primary percutaneous coronary intervention (PCI) is rising, but clinical trials have primarily been performed in younger patients.
  
  
  METHODS
  Patients undergoing primary PCI between 2003 and 2008 were subdivided into 3 groups: < 60, 60-79, and ≥ 80 years. Endpoints at 3-year follow-up included all-cause mortality, recurrent myocardial infarction (reMI), stent thrombosis, target lesion revascularisation (TLR), bleeding (BARC bleeding ≥ 3), stroke, and major adverse cardiovascular events (MACE, a composite of cardiac mortality, reMI, stroke and TLR).
  
  
  RESULTS
  2002 patients with ST-segment elevation myocardial infarction (STEMI) were included, 885 (44.2 %) aged < 60, 921 (46.0 %) 60-79, and 196 (9.7 %) ≥ 80 years. Comorbidities such as diabetes mellitus, prior stroke, malignant disease, anaemia, and chronic kidney disease were more prevalent in patients ≥ 80 years. The incidence of both ischaemic and bleeding events strongly increased with age. Age ≥ 80 years was an independent predictor of mortality (HR 2.56, 95 % CI1.69-3.87, p < 0.001), a borderline non-significant predictor of overall bleeding (HR 1.38, 95 %CI 0.95-2.00, p = 0.088), and a significant predictor of non-access site bleeding (HR 2.26, 95 %CI 1.46-3.51, p < 0.001).
  
  
  CONCLUSIONS
  Patients ≥ 80 years experienced high rates of ischaemic and bleeding complications; especially in this high-risk patient group individualised therapy is needed to optimise clinical outcomes.
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands. b.e.claessen@amc.uva.nl.
authors.forename: Bimmer E P M
authors.initials: BEPM
authors.lastname: Claessen
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Kikkert
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Loes P
authors.initials: LP
authors.lastname: Hoebers
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Hassina
authors.initials: H
authors.lastname: Bahadurzada
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Marije M
authors.initials: MM
authors.lastname: Vis
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Jan G P
authors.initials: JGP
authors.lastname: Tijssen
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.affiliation: Department of Cardiology, B2-115, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands.
authors.forename: José P S
authors.initials: JPS
authors.lastname: Henriques
keywords: Acute myocardial infarction; Elderly; Primary percutaneous coronary intervention; Stent