PMID- 20569706
OWN - NLM
STAT- MEDLINE
DCOM- 20100715
LR  - 20161125
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 159
IP  - 6
DP  - 2010 Jun
TI  - Real-world outcome from ST elevation myocardial infarction in the very elderly 
      before and after the introduction of a 24/7 primary percutaneous coronary 
      intervention service.
PG  - 956-63
LID - 10.1016/j.ahj.2010.02.026 [doi]
AB  - BACKGROUND: It remains unclear whether the superiority of primary percutaneous 
      coronary intervention (PPCI) over thrombolysis for the treatment of ST elevation 
      myocardial infarction (STEMI) extends to the very elderly. Furthermore, the 
      deliverability and efficacy of PPCI in over the 80s has not been investigated in 
      a real-world setting. The aim of this study was to compare outcome from STEMI in 
      patients aged > or =80 before and after the introduction of routine 24/7 PPCI. 
      METHODS: Retrospective observational analysis of all patients aged > or =80 
      presenting with STEMI to 2 neighboring hospitals in the 3-year period after the 
      introduction of a 24/7 PPCI service and in the preceding 2 years when reperfusion 
      therapy was by thrombolysis. RESULTS: Two hundred fifty-six STEMI patients aged > 
      or =80 were included. After the introduction of PPCI, 84% (136/161) received 
      reperfusion therapy, 73% PPCI, and 12% thrombolysis, compared to 77% ([73/95] 1% 
      PPCI, 76% thrombolysis) previously. Mortality after inception of PPCI was reduced 
      at 12 months (29% vs 41%, P = .04) and 3 years (43% vs 58%, P = .02). Improved 
      outcome was attributable to treatment by PPCI, which was associated with 
      numerically lower 12-month (26% vs 37%, P = .07) and significantly reduced 3-year 
      (42% vs 55%, P = .05) mortality compared to thrombolysis. CONCLUSIONS: Primary 
      PCI can be effectively delivered to very elderly patients presenting with ST 
      elevation MI in a real-world setting and leads to a substantial reduction in 
      mortality compared to patients treated by thrombolysis.
CI  - Copyright 2010 Mosby, Inc. All rights reserved.
FAU - Shelton, Rhidian J
AU  - Shelton RJ
AD  - Leeds General Infirmary, Leeds, United Kingdom.
FAU - Crean, Andrew M
AU  - Crean AM
FAU - Somers, Kathryn
AU  - Somers K
FAU - Priestley, Claire
AU  - Priestley C
FAU - Hague, Carol
AU  - Hague C
FAU - Blaxill, Jonathan M
AU  - Blaxill JM
FAU - Wheatcroft, Stephen B
AU  - Wheatcroft SB
FAU - McLenachan, James M
AU  - McLenachan JM
FAU - Greenwood, John P
AU  - Greenwood JP
FAU - Blackman, Daniel J
AU  - Blackman DJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Aged, 80 and over
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Coronary Angiography
MH  - *Electrocardiography
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/diagnostic imaging/physiopathology/*therapy
MH  - Retrospective Studies
MH  - Thrombolytic Therapy/*methods
MH  - Treatment Outcome
EDAT- 2010/06/24 06:00
MHDA- 2010/07/16 06:00
CRDT- 2010/06/24 06:00
PHST- 2009/09/15 00:00 [received]
PHST- 2010/02/24 00:00 [accepted]
PHST- 2010/06/24 06:00 [entrez]
PHST- 2010/06/24 06:00 [pubmed]
PHST- 2010/07/16 06:00 [medline]
AID - S0002-8703(10)00170-5 [pii]
AID - 10.1016/j.ahj.2010.02.026 [doi]
PST - ppublish
SO  - Am Heart J. 2010 Jun;159(6):956-63. doi: 10.1016/j.ahj.2010.02.026.