PMID- 26196017
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150721
LR  - 20240326
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 2
IP  - 1
DP  - 2015
TI  - Treatment choices in elderly patients with ST: elevation myocardial 
      infarction-insights from the Vital Heart Response registry.
PG  - e000235
LID - 10.1136/openhrt-2014-000235 [doi]
LID - e000235
AB  - BACKGROUND: Management of elderly patients with ST elevation myocardial 
      infarction (STEMI) is challenging and they are under-represented in trials. 
      Accordingly, we analysed reperfusion strategies and their effectiveness in 
      patients with STEMI >/=75 years compared to <75 years within a comprehensive 
      inclusive registry. METHODS: Consecutive patients with STEMI admitted to hospital 
      and tracked within a regional registry (2006-2011) were analysed comparing 
      reperfusion strategy (primary percutaneous coronary intervention (PPCI), 
      fibrinolysis and no reperfusion) between patients >/=75 vs <75 years old as well as 
      across the reperfusion strategies in those >/=75 years. RESULTS: There were 3588 
      patients with STEMI with 646 (18%) >/=75 years old. Elderly patients were more 
      likely female (46.9% vs 18.4%) and had more prior: angina (28.2% vs 17.2%), 
      myocardial infarction (MI; 22.8% vs 13.9%), hypertension (67.6% vs 44.2%), heart 
      failure (2.3% vs 0.3%) and atrial fibrillation (2.2% vs 0.5%) (all p<0.001). The 
      reperfusion strategy for patients >/=75 vs <75: PPCI 45.3% vs 41.2%, fibrinolysis 
      24.8% vs 45.7%, and no reperfusion 29.9% vs 13.1% (p<0.001). Time from symptoms 
      to first medical contact (median, 93 vs 78 min p=0.008) and PPCI (median, 166 vs 
      136 min (p<0.001) were longer for >/=75 years. In those >/=75 years outcomes by 
      reperfusion (PPCI, fibrinolysis and none) were: in-hospital death 13.3%, 9.4% and 
      19.7% (p=0.018), and composite of death, recurrent-MI, cardiogenic shock and 
      congestive heart failure 28%, 20% and 33.2% (p=0.022). CONCLUSIONS: Elderly 
      patients have more comorbidities, worst in-hospital clinical outcomes and are 
      less likely to receive reperfusion. Acknowledging physician selection of the 
      reperfusion strategy; outcomes appear favourable in the elderly receiving 
      fibrinolysis.
FAU - Toleva, Olga
AU  - Toleva O
AD  - University of Alberta , Edmonton, Alberta , Canada.
FAU - Ibrahim, Quazi
AU  - Ibrahim Q
AD  - University of Alberta , Edmonton, Alberta , Canada.
FAU - Brass, Neil
AU  - Brass N
AD  - Royal Alexandra Hospital and CK Hui Heart Centre , Edmonton, Alberta , Canada.
FAU - Sookram, Sunil
AU  - Sookram S
AD  - University of Alberta , Edmonton, Alberta , Canada.
FAU - Welsh, Robert
AU  - Welsh R
AD  - University of Alberta , Edmonton, Alberta , Canada ; Mazankowski Alberta Heart 
      Institute, Edmonton, Alberta , Canada.
LA  - eng
PT  - Journal Article
DEP - 20150624
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
PMC - PMC4488892
EDAT- 2015/07/22 06:00
MHDA- 2015/07/22 06:01
PMCR- 2015/06/24
CRDT- 2015/07/22 06:00
PHST- 2014/12/27 00:00 [received]
PHST- 2015/05/12 00:00 [revised]
PHST- 2015/06/03 00:00 [accepted]
PHST- 2015/07/22 06:00 [entrez]
PHST- 2015/07/22 06:00 [pubmed]
PHST- 2015/07/22 06:01 [medline]
PHST- 2015/06/24 00:00 [pmc-release]
AID - openhrt-2014-000235 [pii]
AID - 10.1136/openhrt-2014-000235 [doi]
PST - epublish
SO  - Open Heart. 2015 Jun 24;2(1):e000235. doi: 10.1136/openhrt-2014-000235. 
      eCollection 2015.