[ST elevation myocardial infarction (STEMI) in patients aged 85 and over. Invasive management versus exclusive medical treatment: Departmental study].
BACKGROUND
Percutaneous coronary intervention (PCI) and/or fibrinolysis for management of an ST elevation myocardial infarction (STEMI) are at high risk in the elderly. Is there any place for an invasive management in this particular population?


METHODS
It is a single-center retrospective study (CHD Vendée, La Roche-sur-Yon) including patients aged 85 and over who had STEMI between January 2008 and December 2013, divided into two groups: coronary angiogram/fibrinolysis ("invasive") versus exclusive medical treatment ("non-invasive"), comparing mortality, morbidity, complications and loss of independence.


RESULTS
Among the 1373 patients hospitalized for STEMI, 118 (8.6%) were included: 71 (60.2%) underwent an invasive procedure for reperfusion whereas 47 had "non-invasive" management. All cause mortality rate was higher in the "non-invasive" group (28% versus 45%; P=0.077 NS). The identified pejorative criteria are age, female gender, past history of severe valvular disease, and delay for primary care. No difference was found in intrahospital complication rate (23 vs 21; P=0.21) nor in loss of independence.


CONCLUSIONS
The invasive management of STEMI in the elderly may reduce the one-year mortality rate without increasing morbidity.
Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France. Electronic address: thomas.doizon@chd-vendee.fr.
T
T
Doizon
Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France.
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L
Orion
Service de recherche clinique, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France.
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J
Dimet
Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France.
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E
Boiffard
D000369:Aged, 80 and over; D002318:Cardiovascular Diseases; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D015912:Thrombolytic Therapy
Elderly patients; Myocardial revascularization; Reperfusion myocardique; ST elevation myocardial infarction; Sujets âgés; Syndrome coronarien aigu ST+; Vendée