title: Management of Patients Aged ≥85 Years With ST-Elevation Myocardial Infarction.
abstract: Guidelines mandate urgent revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) irrespective of age. Whether this strategy is optimal in patients aged ≥85 years remains uncertain. We aimed to assess the clinical characteristics and outcomes of patients aged ≥85 years with STEMI stratified by their management strategy. We analyzed baseline clinical characteristics of 101 consecutive patients aged ≥85 years who presented with STEMI to a tertiary Australian hospital. Patients were stratified based on whether they underwent invasive management with urgent coronary angiography ± percutaneous coronary intervention or conservative management. Our primary outcome was long-term mortality. Independent predictors of conservative management and long-term mortality were assessed by multivariate logistic regression and Cox proportional hazard modeling respectively. Of the 101 patients included, 45 underwent invasive management. Independent predictors of having conservative management were older age, anterior STEMI, and cognitive impairment (all p <0.01). Patients managed invasively had lower in-hospital (13.3% vs 32.1%, p = 0.03), 30-day (13.3% vs 37.5%, p <0.01), 12-month (22.2% vs 57.1%, p <0.01), and long-term (40.0% vs 75.0%, p <0.01) mortality. Invasive management was an independent predictor of lower long-term mortality (hazard ratio 0.29, 95% CI 0.11 to 0.76, p <0.01). In conclusion, patients aged ≥85 years with STEMI who were older, had cognitive impairment or presented with anterior ST-elevation were more likely to be managed conservatively. Those who underwent invasive management had reasonable short- and long-term outcomes.
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: matiasyudi@gmail.com.
authors.forename: Matias B
authors.initials: MB
authors.lastname: Yudi
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Dharsh
authors.initials: D
authors.lastname: Fernando
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Jay
authors.initials: J
authors.lastname: Ramchand
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jones
authors.affiliation: Department of Medicine, Western Health, Melbourne, Australia.
authors.forename: Robynne
authors.initials: R
authors.lastname: Dakis
authors.affiliation: Department of Medicine, Austin Health, Melbourne, Australia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Johnson
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Chan
authors.affiliation: Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.
authors.forename: Amirul
authors.initials: A
authors.lastname: Islam
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Omar
authors.initials: O
authors.lastname: Farouque
authors.affiliation: Department of Cardiology, Austin Health, Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Horrigan
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome