title: Factors associated with use of percutaneous coronary intervention among elderly patients presenting with ST segment elevation acute myocardial infarction (STEMI): Results from the ISACS-TC registry.
abstract: BACKGROUND
  A substantial proportion of elderly with ST segment elevation myocardial infarction (STEMI) do not undergo percutaneous coronary intervention (PCI). We sought to investigate factors associated with the decision not to perform coronary angiography at admission in these patients.
  
  
  METHODS
  We evaluated 1315 STEMI patients aged ≥75years old enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS TC) registry between October 2010 and February 2015. They were compared with 6667 patients aged <75years old enrolled in the registry in the same time frame.
  
  
  RESULTS
  Elderly patients were less likely to undertake invasive coronary evaluation compared with younger patients (62.1% vs. 78.9; p<0.001%). In the older group there were a lower proportion of patients presenting <12h after symptom onset (66.5% vs.76.9%, p<0.001), and a higher prevalence of comorbidities. Few elderly were treated with current recommended evidence based treatments (aspirin, clopidogrel, heparins, beta-blocker, statins, and ACE-inhibitors). Logistic analysis adjusted for age and sex showed that older age was associated with underuse of coronary angiography (OR 0.46, 95% CI: 0.41-0.53, p<0.001). Clinical factors that were associated with underuse of angiography in patients over 75 were: female sex (OR: 0.77), presence of comorbidities (OR: 0.91), anemia (OR: 0.44) and late hospital admission (OR: 0.89).
  
  
  CONCLUSIONS
  In the ISACS-TC, more than one third of the elderly with STEMI did not undergo coronary angiography at admission. Sex, comorbidities, and late hospital admission were independent factors associated with the underuse of PCI in these patients.
authors.affiliation: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Câlmâc
authors.affiliation: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania.
authors.forename: Vlad
authors.initials: V
authors.lastname: Bătăilă
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ricci
authors.affiliation: Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Zorana
authors.initials: Z
authors.lastname: Vasiljevic
authors.affiliation: University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia.
authors.forename: Sasko
authors.initials: S
authors.lastname: Kedev
authors.affiliation: Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Olivija
authors.initials: O
authors.lastname: Gustiene
authors.affiliation: University Clinical Centre of the Republic of Srpska, Clinic of Cardiovascular Diseases, Banja Luka, Republika Srpska, Bosnia and Herzegovina.
authors.forename: Dijana
authors.initials: D
authors.lastname: Trininic
authors.affiliation: Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro.
authors.forename: Božidarka
authors.initials: B
authors.lastname: Knežević
authors.affiliation: Department for Cardiovascular Diseases, University of Zagreb, Zagreb, Croatia.
authors.forename: Davor
authors.initials: D
authors.lastname: Miličić
authors.affiliation: Clinical Center University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina.
authors.forename: Mirza
authors.initials: M
authors.lastname: Dilic
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors.forename: Olivia
authors.initials: O
authors.lastname: Manfrini
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors.forename: Edina
authors.initials: E
authors.lastname: Cenko
authors.affiliation: Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Lina
authors.initials: L
authors.lastname: Badimon
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bugiardini
authors.affiliation: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania; Bucharest University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: Alexandru
authors.initials: A
authors.lastname: Scafa-Udriște
authors.affiliation: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania; Bucharest University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Tăutu
authors.affiliation: Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania; Bucharest University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. Electronic address: maria.dorobantu@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Dorobanțu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D019468:Disease Management; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Coronary angiography; Elderly; Reperfusion therapy; STEMI