Management of patients ≥85 years of age 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 that 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 impairments (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% confidence interval 0.11 – 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.