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Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients
  1. Pin Pin Pek1,
  2. Huili Zheng2,
  3. Andrew Fu Wah Ho3,
  4. Win Wah4,
  5. Huay Cheem Tan5,
  6. Ling Li Foo2,
  7. Marcus Eng Hock Ong1,6
  1. 1Department of Emergency Medicine, Singapore General Hospital, Singapore
  2. 2National Registry of Diseases Office, Health Promotion Board, Singapore
  3. 3Emergency Medicine Residency Program, SingHealth Services, Singapore
  4. 4Unit for Prehospital Emergency Care, Department of Emergency Medicine, Singapore General Hospital, Singapore
  5. 5Department of Cardiology, National University Heart Centre, Singapore
  6. 6Health Services and Systems Research, Duke-NUS Medical School, Singapore
  1. Correspondence to Pin Pin Pek, Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore; maeve_sgh{at}yahoo.com

Abstract

Background With an ageing population, there is a need to understand the relative risk/benefit of interventions for elderly ST segment elevation myocardial infarction (STEMI) patients. The primary aim of this study was to compare epidemiology, treatments and outcomes between young and elderly STEMI patients. Our secondary aim was to determine the cut-off age when the benefits of primary percutaneous coronary intervention (PCI) were less pronounced.

Methods Data were collected by the Singapore Myocardial Infarction Registry. Patients were categorised into young (age <65 years) and elderly STEMI (age ≥65 years) patients.

Results We analysed 14 006 STEMI cases collected between January 2007 and December 2014; 33.9% were elderly STEMI patients. Elderly STEMI patients had longer median door to balloon (73 vs 64 min, P<0.001) time and were less likely to receive PCI (proportion difference=−23.6%, 95% CI −25.3 to −22.0). In the absence of PCI, elderly STEMI patients had a higher mortality within 30 days (elderly: HR 1.65, 95% CI 1.36 to 1.99, P<0.001; young: HR 1.10, 95% CI 0.79 to 1.54, P=0.573) and 1 year (elderly: HR 1.83, 95% CI 1.57 to 2.14, P<0.001; young: HR 1.41, 95% CI 1.09 to 1.83, P=0.009) of admission. The 1 year survival benefit of PCI started to decline after the age of 65 years.

Conclusion Elderly STEMI patients were less likely to receive PCI and had longer door to balloon times. Survival benefit of PCI decreased after the age of 65 years, with the decline most evident from age 85 years onwards. The risks of PCI need to be weighed carefully against its benefits, especially in very elderly patients.

  • acute myocardial infarct
  • aged
  • cardiac care, acute coronary syndrome
  • treatment

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Footnotes

  • Contributors PPP, HZ, AFWH and MEHO conceived the study, designed the study and obtained ethics approval. HCT, LLF and MEHO gave clinical advice on the study subject and methodology. PPP, AFWH, MEHO, WW, HZ and LLF supervised the conduct of the study and data related issues. HZ and WW provided statistical advice and analysed the data. PPP drafted the manuscript, and all authors contributed substantially to its revision. PPP takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The Central Institutional Review Board granted approval for this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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