title: Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management.
abstract: BACKGROUND
  Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years are associated with improved 1-year mortality after hospital admission for myocardial infarction.
  
  
  METHODS
  We used data from 4 1-month French registries, conducted 5 years apart from 1995 to 2010, including 3389 elderly patients (≥75 years of age).
  
  
  RESULTS
  From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infarction patients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke, and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infarction (36.8% to 21.1%) and non-ST-elevation myocardial infarction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). The study period, however, was no longer associated with decreased mortality when variables reflecting management changes were taken into account.
  
  
  CONCLUSIONS
  Early and 1-year mortality after hospital admission of elderly patients with acute myocardial infarction has substantially decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France. Electronic address: etienne.puymirat@egp.aphp.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: AP-HP; HEGP, Department of Critical Care Unit, Paris, France; Université Paris-Descartes, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.affiliation: Department of Cardiology, CHU Nîmes, Université de Montpellier, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lafont
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Riant
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France; Humanitas Clinical and Research Center, Cardiovascular Department, Rozzano (Milano), Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mennuni
authors.affiliation: AP-HP; HEGP, Department of Geriatrics, Paris, France; Université Paris-Descartes, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Saint-Jean
authors.affiliation: Department of Cardiology, Clinique Saint Gatien, Tours, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Department of Cardiology, Centre Hospitalier de Pontoise, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jourdain
authors.affiliation: Department of Cardiology, Toulouse University Hospital, France.
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.affiliation: AP-HP, Hôpital Lariboisière, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bataille
authors.affiliation: AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Drouet
authors.affiliation: French Society of Cardiology, Paris, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Mulak
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.affiliation: Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute myocardial infarction; Coronary angiography; Elderly; Mortality; Percutaneous coronary intervention