Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. May 26, 2017; 9(5): 437-441
Published online May 26, 2017. doi: 10.4330/wjc.v9.i5.437
Clinical characteristics and outcomes of octogenarians presenting with ST elevation myocardial infarction in the Australian population
Wei Liang Sim, Vivek Mutha, Muhammad Asrar Ul-Haq, Victoria Sasongko, William Van-Gaal
Wei Liang Sim, Victoria Sasongko, William Van-Gaal, Department of Cardiology, Northern Hospital, Epping, Victoria 3076, Australia
Vivek Mutha, Department of Cardiology, Monash Health, Melbourne, Victoria 3168, Australia
Muhammad Asrar Ul-Haq, Department of Cardiology, the University of Melbourne, Melbourne, Victoria 3010, Australia
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at wei_liangs@hotmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Wei Liang Sim, Department of Cardiology, Northern Hospital, 185 Cooper Street, Epping, Victoria 3076, Australia. wei_liangs@hotmail.com
Telephone: +61-04-28909100
Received: August 26, 2016
Peer-review started: August 29, 2016
First decision: October 28, 2016
Revised: February 20, 2017
Accepted: March 21, 2017
Article in press: March 22, 2017
Published online: May 26, 2017
Abstract
AIM

To investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction (STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention (PCI) compared to those managed conservatively.

METHODS

We performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included. The subsequent non-octogenarian patient who presented with a STEMI following the octogenarian patient was assigned to the control group in a 1:1 manner. The outcomes measured were peri-procedural cardiac arrest, death on table, cerebrovascular accidents (CVA), in-hospital and 30-d mortality.

RESULTS

A total of 146 patients were analyzed. The octogenarian group had a higher percentage of females, higher overall comorbidities, higher Charlson Comorbidity Index score, worse renal function and were more likely to require residential care and home help. The octogenarian group were also less likely to have PCI attempted and had a longer symptom onset to PCI time. Mortality rate was high amongst octogenarians who presented with STEMI. However, those managed conservatively had a higher in-hospital and 30-d mortality rate

CONCLUSION

Octogenarians who presented with STEMI that were managed conservatively had a higher mortality rate compared to those who had primary PCI. Therefore, we propose that revascularization may be beneficial to patients in this age group.

Keywords: Coronary disease, Acute coronary syndrome, Myocardial infarction, Percutaneous coronary intervention, Aged 80 and over

Core tip: The octogenarian group represents a complex population with multiple comorbidities. Percutaneous coronary intervention in this group is challenging and is associated with a high rate of failure and complications. This study shows that the mortality rate amongst octogenarians presenting with ST elevation myocardial infarction is high. However, there may be a mortality benefit in those treated with percutaneous coronary intervention, compared to those managed conservatively.