title: Comparison of Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention Analyzed by Age Groups (<75, 75 to 85, and >85 Years); (Results from the Bremen STEMI Registry).
abstract: As old patients, who were treated by percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), are regularly excluded or underrepresented in randomized trials, data on treatment and outcomes of this patient group at high risk have to be collected by registries. The study population of the German Bremen STEMI Registry was divided into the age groups G1: <75 years (n = 4,108, young), G2: 75 to 85 years (n = 1,032, old), and G3: >85 years (n = 216, very old) and was evaluated for clinical management and course. PCI failure (Thrombolysis In Myocardial Infarction flow 0 or 1 after PCI) was observed more often with increasing age. Patients >85 years without successful PCI had a very high inhospital mortality (40.0% without PCI success vs 18.1% with PCI success, p <0.05). Despite a reduced rate of periinterventional treatment with glycoprotein IIb/IIIa inhibitors in elderly patients of G2 and G3, inhospital bleedings (Thrombolysis In Myocardial Infarction/Bleeding Academic Research Consortium ≥2) occurred more frequently in these patients (G1: 5.4% vs G2: 11.0% vs G3: 19.6%, p <0.0001). Mortality rates during inhospital and long-term course increased with increasing age. In a multivariate analysis successful PCI was associated with improved outcomes in all age groups; even in very old patients successful PCI was associated with a significantly lower inhospital mortality rate (odds ratio 0.26, 95% confidence interval 0.08 to 0.81) and a trend toward a lower 1-year mortality. In conclusion, the present "real-world" data demonstrate an elevated rate of PCI failure, bleeding complications, and mortality in elderly patients treated by primary PCI for STEMI. However, a beneficial effect of successful PCI on mortality was observed in all age groups, even in very old patients, indicating the crucial role of revascularization therapy.
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fach
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Bünger
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Zabrocki
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schmucker
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Paulina
authors.initials: P
authors.lastname: Conradi
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Garstka
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Eduard
authors.initials: E
authors.lastname: Fiehn
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.affiliation: Bremer Institut für Herz- und Kreislaufforschung, Klinikum Links der Weser, Bremen, Germany. Electronic address: harm.wienbergen@klinikum-bremen-ldw.de.
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult