3 STEMI care in octogenarians and nonagenarians: a 5-year review from an Irish PPCI centre

IntroductionAt present, relatively little is known about the outcomes of STEMI in the octogenarian and nonagenarian populations as they have been under-represented in previous studies. An increasing population of elderly patients with risk factors for CAD has resulted in an increase in the number of elderly patients presenting with ST elevation myocardial infarction (STEMI). The acute management of patients >80 years with STEMI is fraught with difficulty due to a higher risk from STEMI alongside a higher risk of complications from any treatment undertaken.MethodsRetrospective cohort analysis was conducted on all patients presenting to University Hospital Limerick over the age of 80 presenting with STEMI between January 2012 and December 2017. Patient-level data was sourced from electronic and paper patient records. Standard Bayesian statistics were employed for analysis.ResultsA total of 1,268 patients presented with STEMI during this period. 172 (13.6%) were 80 years or older. Of this subgroup, 159/172 (92.4%) were true STEMI. 124/159 (77.9%) patients were brought to the catheterization lab and 35/159 (22%) were managed medically. 107/159 (67.29%) had angiographic evidence of acute total or partial thrombotic occlusion, and of these 97/107 were treated with PPCI (figure 1). Overall mortality at 1 year was 26.4% (42/159), and patients in the PPCI group had numerically lower 30 day mortality compared with the conservative group (20.6% vs 37.1% respectively, p=0.07). At one year follow-up, there was a significantly higher mortality observed in the conservative group versus the PPCI group (48.6% vs 22.4% respectively, p=0.005) (figure 2). Average length of stay for patients brought to catheterization laboratory was 5.53±8.2days. Of the patients brought to the cardiac catheterization laboratory (n=124), 16 patients (12.9%) exhibited cardiogenic shock, with 9 of these (56.25%) requiring intra-aortic balloon pump insertion. The presence of cardiogenic shock was associated with 87.5% mortality in those who were brought to the catheterization laboratory. In those who were brought for intervention, the mortality associated with cardiogenic shock was associated with a hazard ratio of 9.95 (95% CI 5.0061–19.7888, p=