Modalities of treatment and 30-day outcomes of unselected patients older than 75 years with acute ST-elevation myocardial infarction: data from the BLITZ study

Leonardo De Luca, Leonardo Bolognese, Gianni Casella, Stefano Savonitto, Lucio Gonzini, Antonio Di Chiara, Stefano De Servi, Salvatore Notaristefano, Laura Valagussa, Aldo P Maggioni, Francesco Chiarella et al.
Journal of Cardiovascular Medicine 2008, 9 (10): 1045-51

BACKGROUND: The optimal treatment strategy for elderly patients presenting with ST-elevation myocardial infarction is still controversial and few investigations have studied this high-risk population in a community setting.

METHODS: We analyzed data from the BLITZ survey on patients with any acute myocardial infarction admitted to the Italian Coronary Care Unit (CCU) network, in order to assess current treatment strategies among unselected patients older than 75 years presenting with ST-elevation myocardial infarction. We also evaluated the 30-day rates of major adverse cardiovascular events (death/re-myocardial infarction/stroke) relative to different treatment strategies.

RESULTS: The registry included 1959 patients, of whom 529 (27%) were over 75 years old. According to the ECG on admission, 296 of these patients (56%) were classified as having ST-elevation myocardial infarction: 26 (8.8%) underwent primary percutaneous coronary intervention, 101 (34.1%) were treated with systemic thrombolysis, and the remaining 169 (57.1%) did not receive any early reperfusion therapy. At 30-day follow-up, the cumulative rate of major adverse cardiovascular events was not significantly different among the three treatment modality groups (31.4, 27.7, and 23.1% among no reperfusion, thrombolysis and primary percutaneous coronary intervention groups, respectively; P = 0.59). On multivariable analysis, age [odds ratio (OR) x 5-year increment 1.5; 95% confidence interval (CI) 1.2-2.0; P = 0.007], Killip class II-IV at admission (OR 3.7; 95% CI 2.1-6.3; P < 0.0001), and coronary multivessel disease (OR 2.4; 95% CI 1.1-5.3; P = 0.03) were the only independent predictors of major adverse cardiovascular events.

CONCLUSION: In a nationwide clinical practice, the vast majority of patients older than 75 years presenting with ST-elevation myocardial infarction does not receive any early reperfusion treatment and presents a significant incidence of major clinical events at 30 days.

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