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Trends and Impact of Door-to-Balloon Time on Clinical Outcomes in Patients Aged <75, 75 to 84, and ≥85 Years With ST-Elevation Myocardial Infarction. |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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#PLACEHOLDER_PARENT_METADATA_VALUE# |
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| DOI |
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10.1016/j.amjcard.2017.07.005 |
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| Abstract |
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Guidelines
strongly recommend patients with ST-elevation myocardial infarction (STEMI)
receive timely mechanical reperfusion, defined as door-to-balloon time (DTBT)
≤90 minutes. The impact of timely reperfusion on clinical outcomes in patients
aged 75-84 and ≥85 years is uncertain. We analysed 2,972 consecutive STEMI
patients who underwent primary percutaneous coronary intervention from the
Melbourne Interventional Group Registry (2005-2014). Patients aged <75 years
were included in the younger group, those aged 75-84 years were in the elderly
group and those ≥85 years were in the very elderly group. The primary endpoints
were 12-month mortality and major adverse cardiovascular events (MACE). 2,307
(77.6%) patients were <75 years (mean age 59 ± 9 years), 495 (16.7%) were
75-84 years and 170 (5.7%) were ≥85 years. There has been a significant decrease
in DTBT over 10 years in younger and elderly patients (p-for-trend <0.01 and
0.03) with a trend in the very elderly (p-for-trend 0.08). Compared to younger
and elderly patients, the very elderly had higher 12-month mortality (3.6% vs
10.7% vs. 29.4%; p = 0.001) and MACE (10.8% vs 20.6% vs 33.5%; p = 0.001). DTBT
≤90 minutes was associated with improved outcomes on univariate analysis but was
not an independent predictor of improved 12-month mortality (OR 0.84, 95% CI
0.54-1.31) or MACE (OR 0.89, 95% CI 0.67-1.16). In conclusion, over a 10-year
period, there was an improvement in DTBT in patients aged <75 years and 75-84
years however DTBT ≤90 minutes was not an independent predictor of 12-month
outcomes. Thus assessing whether patients aged ≥85 years are suitable for
invasive management does not necessarily translate to worse clinical
outcomes. |
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| Citation |
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The American Journal of Cardiology 2017; 120(8): 1245-1253 |
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| Jornal Title |
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The American Journal of Cardiology |
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