PMID- 34873049
OWN - NLM
STAT- MEDLINE
DCOM- 20220202
LR  - 20220202
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 8
IP  - 2
DP  - 2021 Dec
TI  - Activation of PPCI team in the octogenarian and nonagenarians population: 
      real-world single-centre experience.
LID - 10.1136/openhrt-2021-001709 [doi]
LID - e001709
AB  - OBJECTIVE: Advancement in healthcare provision has led to increasing octogenarian 
      ST elevation myocardial infarction (STEMI) presentation to hospital for early 
      revascularisation therapies. Limited literature to date exists to suggest 
      octogenarian STEMI population; with majority of trials excluding these age group 
      patients. Due to an ageing population, we expect increasing rates of STEMI in the 
      octogenarian and nonagenarian population in the future. This study seeks to 
      identify the outcomes of patients over the age of 80 presenting with STEMI and 
      determine the factors associated with better or worse outcome. PATIENTS AND 
      METHODS: This study is a single-centre retrospective observational study 
      involving patients' age 80 or older presenting with STEMI between January 2014 
      and December 2019. Patient data were collected by chart review and analysis of 
      the local STEMI database. Standard Bayesian statistics were employed for 
      analysis. RESULTS: 1301 patients presented with STEMI during this period. 
      159/1301 (12.2%) were 80 years or older that fulfilled STEMI criteria, 35/159 
      (22.1%) were medically managed. 107/124 (86.29%) had angiographic evidence of 
      acute total or partial thrombotic occlusion, and 97/107 were treated with primary 
      percutaneous coronary intervention (PPCI). The activation ECG most commonly 
      exhibited an anterior STEMI, while inferior STEMI ECGs had the strongest positive 
      predictive value. PPCI group had a 30-day mortality rate of 20% (p=0.07) and 
      1-year mortality was 22.4%. Highest mortality was observed with cardiogenic 
      shock, low ejection fraction, higher high sensitivity cardiac troponin T and 
      creatinine at presentation. Conservatively managed patients had significant 
      higher mortality rate (48% vs 22.4%, p=0.005) at 1 year. CONCLUSION: Patients 
      over the age of 80 who present with STEMI and undergo PPCI have a significantly 
      lower mortality rate at 1 year. These patients have a 77.6% survival at 1 year, 
      with 92.4% likelihood of discharge to home (without need for long-term nursing 
      home care). Cardiogenic shock in this group was associated with a 1-year 
      mortality of 87.5%. Despite the advanced age, we suggest favourable outcomes 
      described in the absence of patients presenting with cardiogenic shock.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Kumar, Rajesh
AU  - Kumar R
AUID- ORCID: 0000-0002-8002-1551
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland 
      rajesh2k7@yahoo.com.
FAU - O'Connor, Cormac
AU  - O'Connor C
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Kumar, Jathinder
AU  - Kumar J
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Kerr, Brain
AU  - Kerr B
AUID- ORCID: 0000-0002-4071-8960
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Malik, Ihtisham
AU  - Malik I
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Homer, Ciarrai
AU  - Homer C
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Abbas, Syed
AU  - Abbas S
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Arnous, Samer
AU  - Arnous S
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Ullah, Ihsan
AU  - Ullah I
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
FAU - Kiernan, Thomas John
AU  - Kiernan TJ
AD  - Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
SB  - IM
MH  - Aged, 80 and over
MH  - Bayes Theorem
MH  - *Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Incidence
MH  - Ireland/epidemiology
MH  - Male
MH  - Nonagenarians
MH  - Percutaneous Coronary Intervention/*methods
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Risk Factors
MH  - ST Elevation Myocardial Infarction/diagnosis/epidemiology/*surgery
MH  - Survival Rate/trends
PMC - PMC8650482
OTO - NOTNLM
OT  - STEMI
OT  - delivery of health care
OT  - percutaneous coronary intervention
COIS- Competing interests: None declared.
EDAT- 2021/12/08 06:00
MHDA- 2022/02/03 06:00
PMCR- 2021/12/06
CRDT- 2021/12/07 05:59
PHST- 2021/05/01 00:00 [received]
PHST- 2021/11/08 00:00 [accepted]
PHST- 2021/12/07 05:59 [entrez]
PHST- 2021/12/08 06:00 [pubmed]
PHST- 2022/02/03 06:00 [medline]
PHST- 2021/12/06 00:00 [pmc-release]
AID - openhrt-2021-001709 [pii]
AID - 10.1136/openhrt-2021-001709 [doi]
PST - ppublish
SO  - Open Heart. 2021 Dec;8(2):e001709. doi: 10.1136/openhrt-2021-001709.