title: Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group.
abstract: ST-segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
  
  
  
  We analyzed 10 249 consecutive patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all-cause mortality at a median follow-up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In-hospital mortality (7.7% vs 2.4%, P<0.0001) and long-term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07-1.09, P<0.0001). Time-stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long-term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts.
  
  
  
  In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in-hospital outcomes were reasonable, and long-term mortality rates were static.
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Bromage
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
authors.forename: Krishnaraj S
authors.initials: KS
authors.lastname: Rathod
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Grout
authors.affiliation: Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: M Bilal
authors.initials: MB
authors.lastname: Iqbal
authors.affiliation: St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK.
authors.forename: Pitt
authors.initials: P
authors.lastname: Lim
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Jain
authors.affiliation: Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Sundeep S
authors.initials: SS
authors.lastname: Kalra
authors.affiliation: UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Crake
authors.affiliation: St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Astroulakis
authors.affiliation: UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK.
authors.forename: Mick
authors.initials: M
authors.lastname: Ozkor
authors.affiliation: Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Roby D
authors.initials: RD
authors.lastname: Rakhit
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Knight
authors.affiliation: Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Miles C
authors.initials: MC
authors.lastname: Dalby
authors.affiliation: Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK.
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.affiliation: BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Philip A
authors.initials: PA
authors.lastname: MacCarthy
authors.affiliation: Barts Health NHS Trust, St Bartholomew's Hospital, London, UK andrew.wragg@bartshealth.nhs.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wragg
mesh_terms: D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D015607:Stents / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute myocardial infarction; aging; cardiovascular disease; complications; elderly; epidemiology; octogenarian; outcome; primary percutaneous coronary intervention