ST-segment elevation myocardial infarction (STEMI) is increasingly common among a growing population of patients in their nineties, according to a study published in the American Journal of Cardiology Oct. 11.
Corresponding author Manel Sabate, PhD, of the University of Barcelona, and colleagues said in the journal that although older adults are the fastest-growing age group among CV patients, they tend to be underrepresented in clinical trials involving STEMI. Nonagenarians represent some 1.5% of the total population in certain developed countries, and a paucity of clinical data about their heart health makes it hard to balance the risks and benefits of treatment guidelines that were designed for a younger populace.
Sabate et al.’s study involved comparing in-hospital and one-year clinical outcomes between nonagenarians treated with optimal medical therapy alone and those who received primary percutaneous coronary intervention (pPCI) as a treatment for STEMI. A consecutive 167 patients were recruited for the project at two academic centers in Spain between 2006 and 2018.
The researchers logged all-cause mortality data for patients during their index hospitalizations and one year into follow-up. The majority of study participants were female—60%—and were on average 92 years old.
Sabate and colleagues reported that 60% of patients underwent emergent catheterization and 50% underwent pPCI during the study period, resulting in a 22% in-hospital mortality rate and 41% one-year mortality rate. The pPCI cohort saw lower mortality than their counterparts who received optimal therapy alone—12% vs. 32% at hospitalization and 26% vs. 45% at one year.
Multivariable analysis identified four independent predictors of all-cause mortality at one year of follow-up:
- Mechanical complications (9.3-fold increased risk of death)
- Killip class III/IV (4.2-fold increased risk of death)
- Serum creatinine at admission (1.8-fold increased risk of death)
- pPCI (48% decreased risk of death)
“All previous studies have suggested that pPCI may be offered in selected nonagenarians with acute MI,” Sabate and co-authors wrote. “In our study, the pPCI group achieved better survival than patients in the medical therapy group, who were more likely to die in-hospital.”
The team said they noted an increase in the use of pPCI as the “treatment of choice” in the older population, which makes sense since PCI use has been on the rise globally among nonagenarians. At the beginning of their study, the researchers said medical therapy alone was the primary treatment choice, with just 17% of cases receiving pPCI before 2010, but after that marker pPCI began to eclipse traditional treatment.
“Our results should be considered as hypothesis-generating,” Sabate et al. said. “Future randomized studies are needed to compare conservative management vs. percutaneous revascularization for the treatment of STEMI in this growing population group.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.