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Title: 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.
Austin Authors: Yudi, Matias B ;Hamilton, Garry;Farouque, Omar ;Andrianopoulos, Nick;Duffy, Stephen J;Lefkovits, Jeffrey;Brennan, Angela;Fernando, Dharsh;Hiew, Chin;Freeman, Melanie;Reid, Christopher M;Dakis, Robynne;Ajani, Andrew E;Clark, David J 
Affiliation: Cardiology
Department of Medicine, University of Melbourne, Melbourne, Australia
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Cardiology, Geelong Hospital, Geelong, Australia
Department of Cardiology, Box Hill Hospital, Melbourne, Australia
School of Public Health, Curtin University, Perth, Western Australia, Australia
Department of Medicine, Western Health, Melbourne, Australia
Issue Date: 15-Oct-2017
Date: 2017-07-28
Publication information: The American Journal of Cardiology 2017; 120(8): 1245-1253
Abstract: 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.
DOI: 10.1016/j.amjcard.2017.07.005
ORCID: 0000-0002-3706-4150
Journal: The American Journal of Cardiology
PubMed URL: 28886858
Type: Journal Article
Appears in Collections:Journal articles

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