Age-Related Differences in Reperfusion Therapy and Outcomes for ST-Segment Elevation Myocardial Infarction.
J Am Geriatr Soc
; 66(7): 1325-1331, 2018 07.
Article
em En
| MEDLINE
| ID: mdl-29684242
ABSTRACT
OBJECTIVES:
To compare timely access to reperfusion therapy and outcomes according to age of older adults with ST-segment elevation myocardial infarction (STEM) managed within an integrated regional system of care.DESIGN:
Ongoing, prospective, regional, hospital-based clinical registry.SETTING:
Twenty-three public and private hospitals in the Northern Alps in France.PARTICIPANTS:
Individuals presenting with STEMI evolving for less than 12 hours from symptom onset between January 2009 and December 2015 (N=4,813; 3,716 (77.2%) <75, 782 (16.2%) 75-84, 315 (6.5%) ≥85). MEASUREMENTS Delivery of any reperfusion therapy (primary percutaneous coronary intervention (PCI), intravenous fibrinolysis), primary PCI, and timely reperfusion therapy and in-hospital outcomes.RESULTS:
The percentages of patients receiving any reperfusion therapy were 92.9% for those younger than 75, 89.0% for those aged 75 to 84, and 78.7% for those aged 85 and older (P < .001). The percentages of patients undergoing primary PCI were 63.7%, 70.3%, 72.4% (P < .001); and the percentages of patients receiving timely delivery of reperfusion therapy were 44.6%, 36.8%, 29.9% (P < .001). In-hospital all-cause mortality was 3.4% for those younger than 75, 10.2% for those aged 75 to 84, and 19.8% for those aged 85 and older (P <.001). In multivariable analysis adjusting for baseline characteristics, timely delivery of reperfusion therapy was associated with lower in-hospital mortality (adjusted odds ratio=0.63, 95% confidence interval=0.46-0.85) with no significant heterogeneity between age groups (P-value for interaction = .45).CONCLUSION:
Older adults meeting contemporary eligibility criteria for reperfusion therapy continue to receive delayed reperfusion therapy and experience higher mortality than their younger counterparts.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Intervenção Coronária Percutânea
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Infarto do Miocárdio com Supradesnível do Segmento ST
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Necessidades e Demandas de Serviços de Saúde
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Am Geriatr Soc
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
França