Reperfusion Strategies and Quality of Care in 5339 Patients Age 80 Years or Older Presenting With ST‐Elevation Myocardial Infarction: Analysis from Get With The Guidelines‐Coronary Artery Disease
Authors: Medina Hector M. , Cannon Christopher P. , Fonarow Gregg C. , Grau‐Sepulveda Maria V. , Hernandez Adrian F. , Frank Peacock W. , Laskey Warren , Peterson Eric D. , Schwamm Lee , Bhatt Deepak L. ,   on behalf of the GWTG Steering Committee and Investigators
Published: June 2012

Background:

Data regarding reperfusion strategies, adherence to national guidelines, and in‐hospital mortality in ST‐elevation myocardial infarction (STEMI) patients age ≥80 years are limited. The aim of this study was to determine current reperfusion trends, medical treatment, and in‐hospital mortality during STEMI in older adults.

Hypothesis:

Among patients aged 80 or above presenting with STEMI, adherence to guidelines, length of stay, and in‐hospital mortality would be better in those receiving reperfusion versus those who did not.

Methods:

Using the Get With The Guidelines‐Coronary Artery Disease (GWTG‐CAD) database, we examined care and in‐hospital outcomes of STEMI patients ≥80 years old. Use of evidence‐based therapies and quality measures were analyzed by reperfusion strategies.

Results:

A total of 5339 patients age ≥80 years hospitalized with STEMI were included. Of these, 42.8% (n = 2285) underwent primary percutaneous coronary intervention (PPCI), 4.8% (n = 255) underwent thrombolysis (TL), and 52.4% (n = 2799) received no reperfusion (NR). Patients with NR were more likely to be older, female, have lower body mass index, and higher prevalence of renal insufficiency and heart failure compared with PPCI or TL patients. During the last decade, there was a significant increase in the use of PPCI compared with TL as the main reperfusion strategy in this population. Adjusted in‐hospital mortality in PPCI patients was lower compared with NR patients (odds ratio [OR]: 0.41, 95% confidence interval [CI]: 0.35‐0.49); also, patients undergoing PPCI or TL had lower mortality compared with NR patients (OR: 0.47, 95% CI: 0.40‐0.55).

Conclusions:

Among patients ≥80 years old admitted with STEMI to GWTG‐CAD hospitals, less than half undergo mechanical or pharmacological reperfusion. However, the proportion of patients undergoing PPCI has increased substantially over the 8‐year study period. Patients undergoing PPCI or TL had lower in‐hospital mortality compared with the NR strategy. Clin. Cardiol. 2012 doi: 10.1002/clc.22036

Get With The Guidelines‐Coronary Artery Disease (GWTG‐CAD) is a program of the American Heart Association and is supported in part by an unrestricted educational grant from Merck/Schering‐Plough Pharmaceutical and Pfizer. The analysis of registry data was performed at Duke Clinical Research Institute (Durham, NC), which receives funding from the American Heart Association. The sponsors were not involved in the design, analysis, preparation, review, or approval of this manuscript.

C.P.C.: research grants, Accumetrics, AstraZeneca, GlaxoSmithKline, Merck, Takeda; advisory board, Intekrin Therapeutics; honoraria, Bristol‐Myers Squibb/Sanofi, Novartis, Alnylam; clinical advisor, Pfizer and AstraZeneca; equity, Automedics Medical Systems. A.F.H.: research grants, Johnson & Johnson/Scios, GSK, Medtronic, Novartis; honoraria, Medtronic, Novartis, AstraZeneca. G.C.F.: research grant, NIH; consultant, Novartis. F.P.: research grants, Abbott, Alere, BAS, Brahms, EKR, Nanosphere, The Medicine's Company; consultant, Abbott, Alere, Beckman Coulter, Electrocore, The Medicine's Company; speaker's bureau, Abbott, Alere; ownership interest, Comprehensive Research Associates LLC, Vital Sensors, Emergencies in Medicine LLC. L.S.: chairman, Get With The Guidelines Steering Committee. E.D.P.: research grants, BMS/Sanofi Research, Eli Lilly Research, Merck Research, Johnson & Johnson. D.L.B.: advisory board, Medscape Cardiology; board of directors, Boston VA Research Institute, Society of Chest Pain Centers; chair, American Heart Association Get With The Guidelines Science Subcommittee; honoraria, American College of Cardiology (Editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), WebMD (CME steering committees); research grants, Amarin, AstraZeneca, Bristol‐Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company; unfunded research, FlowCo, PLx Pharma, Takeda. The authors have no other funding, financial relationships, or conflicts of interest to disclose.